Provider Demographics
NPI:1659477370
Name:LAVIE, JACOBO (DDS)
Entity Type:Individual
Prefix:
First Name:JACOBO
Middle Name:
Last Name:LAVIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOUTH BROADWAY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4504
Mailing Address - Country:US
Mailing Address - Phone:914-631-6688
Mailing Address - Fax:914-332-6068
Practice Address - Street 1:200 SOUTH BROADWAY
Practice Address - Street 2:SUITE 109
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4504
Practice Address - Country:US
Practice Address - Phone:914-631-6688
Practice Address - Fax:914-332-6068
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0353391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics