Provider Demographics
NPI:1396582565
Name:STUDIO DENTAL CENTER FOR ADVANCED DENTISTRY
Entity type:Organization
Organization Name:STUDIO DENTAL CENTER FOR ADVANCED DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVENKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-255-2176
Mailing Address - Street 1:11860 NW 21ST CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1955
Mailing Address - Country:US
Mailing Address - Phone:786-255-2176
Mailing Address - Fax:
Practice Address - Street 1:12150 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33323-2227
Practice Address - Country:US
Practice Address - Phone:954-669-1469
Practice Address - Fax:954-669-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental