Provider Demographics
NPI:1528040755
Name:LAFOND AND TAMBINI DMD, PA
Entity Type:Organization
Organization Name:LAFOND AND TAMBINI DMD, PA
Other - Org Name:JONATHAN M. LAFOND DMD, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INSURANCE COORDIANTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAFOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-851-0104
Mailing Address - Street 1:455 TROLLEY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5669
Mailing Address - Country:US
Mailing Address - Phone:843-851-0104
Mailing Address - Fax:843-851-0210
Practice Address - Street 1:455 TROLLEY RD
Practice Address - Street 2:SUITE E
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5669
Practice Address - Country:US
Practice Address - Phone:843-851-0104
Practice Address - Fax:843-851-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9862Medicaid
SCZA9862Medicaid