Individual
DR. JENNA LAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4300 KINGS HWY STE 500, PORT CHARLOTTE, FL 33980-2953
(239) 344-2337
Mailing address
PO BOX 919771, ORLANDO, FL 32891-9771
(239) 278-3600
(239) 479-5122
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN25841
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110812700
—
FL
Enumeration date
05/26/2021
Last updated
08/18/2021
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