Provider Demographics
NPI:1902199763
Name:LAVU DENTAL P.C.
Entity Type:Organization
Organization Name:LAVU DENTAL P.C.
Other - Org Name:FAMILY DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-966-9554
Mailing Address - Street 1:3021 ROLLING WOOD LN
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-0365
Mailing Address - Country:US
Mailing Address - Phone:817-788-0776
Mailing Address - Fax:
Practice Address - Street 1:6924 SOUTH FWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-3800
Practice Address - Country:US
Practice Address - Phone:817-293-7431
Practice Address - Fax:817-293-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24206122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty