Provider Demographics
NPI:1881600435
Name:LAVETTI, MARK S (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:LAVETTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 HIGH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2150
Mailing Address - Country:US
Mailing Address - Phone:301-843-7303
Mailing Address - Fax:301-645-6063
Practice Address - Street 1:85 HIGH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2150
Practice Address - Country:US
Practice Address - Phone:301-843-7303
Practice Address - Fax:301-645-6063
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD70171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice