Provider Demographics
NPI:1205045978
Name:MANUEL & EMILY LAVARIAS, D.D.S., INC.
Entity type:Organization
Organization Name:MANUEL & EMILY LAVARIAS, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-216-7412
Mailing Address - Street 1:885 CANARIOS CT
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7877
Mailing Address - Country:US
Mailing Address - Phone:619-216-7412
Mailing Address - Fax:616-216-7316
Practice Address - Street 1:885 CANARIOS CT
Practice Address - Street 2:SUITE 206
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7877
Practice Address - Country:US
Practice Address - Phone:619-216-7412
Practice Address - Fax:616-216-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty