Organization
LIT DENTAL, P.C.
Active
Other names
Courtney Lavigne Dentistry, Lit Dental Esthetics & Implant Center
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL ORTIZ DMD (OWNER/PROSTHODONTIST)
(626) 315-2028
Entity
Organization
Contact information
Practice address
109 ANDREW AVE STE 202, WAYLAND, MA 01778-3157
(508) 358-2122
Mailing address
109 ANDREW AVE STE 202, WAYLAND, MA 01778-3157
(508) 358-2122
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0700X
Prosthodontics
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN1857495
LICENSE NUMBER
MA
Enumeration date
02/05/2020
Last updated
02/05/2020
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