Provider Demographics
NPI:1982947651
Name:GAVILLA, LAZARO F (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAZARO
Middle Name:F
Last Name:GAVILLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 NE 14TH STREET CSWY STE 4
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3535
Mailing Address - Country:US
Mailing Address - Phone:305-586-3767
Mailing Address - Fax:
Practice Address - Street 1:2701 NE 14TH STREET CSWY STE 4
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3535
Practice Address - Country:US
Practice Address - Phone:754-205-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057508-1122300000X
FLDN20449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist