Provider Demographics
NPI:1720029754
Name:GARVAR, LANNY R (DMD)
Entity Type:Individual
Prefix:
First Name:LANNY
Middle Name:R
Last Name:GARVAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 N UNIVERSITY DR
Mailing Address - Street 2:102
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2979
Mailing Address - Country:US
Mailing Address - Phone:954-721-7990
Mailing Address - Fax:954-720-9484
Practice Address - Street 1:7401 N UNIVERSITY DR
Practice Address - Street 2:102
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2979
Practice Address - Country:US
Practice Address - Phone:954-721-7990
Practice Address - Fax:954-720-9484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0005375204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL85248AOtherBLUE CROSS BLUE SHIELD
DCG67896OtherUNITED CONCORDIA
FLT85684Medicare UPIN
FL85248AMedicare ID - Type UnspecifiedPROVIDER