Provider Demographics
NPI:1750495172
Name:LAVANDERO, MARIA D I (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:D
Last Name:LAVANDERO
Suffix:I
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 SILAS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5147
Mailing Address - Country:US
Mailing Address - Phone:336-777-1272
Mailing Address - Fax:
Practice Address - Street 1:2041 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5147
Practice Address - Country:US
Practice Address - Phone:336-777-1272
Practice Address - Fax:336-777-1196
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry