Provider Demographics
NPI:1942304647
Name:LAVELLE, PAUL THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:LAVELLE
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 1:13104 US HWY 42
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059
Mailing Address - Country:US
Mailing Address - Phone:502-228-0234
Mailing Address - Fax:502-228-3127
Practice Address - Street 1:13104 US HWY 42
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059
Practice Address - Country:US
Practice Address - Phone:502-228-0234
Practice Address - Fax:502-228-3127
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48851223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health