Provider Demographics
NPI:1780127894
Name:TORTIKER, LAVANYA (DMD)
Entity type:Individual
Prefix:
First Name:LAVANYA
Middle Name:
Last Name:TORTIKER
Suffix:
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 1:7522 LEE DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3603
Mailing Address - Country:US
Mailing Address - Phone:804-559-1016
Mailing Address - Fax:
Practice Address - Street 1:7522 LEE DAVIS RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111
Practice Address - Country:US
Practice Address - Phone:804-559-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014154261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice