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Organization

DECKER & LAVINE, DDS, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID LAVINE D.D.S., M.S. (OWNER)
(301) 776-3066
Entity
Organization

Contact information

Practice address
14333 LAUREL BOWIE RD, SUITE 201, LAUREL, MD 20708-1126
(301) 776-3066
(301) 776-3115
Mailing address
14333 LAUREL BOWIE RD, SUITE 201, LAUREL, MD 20708-1126
(301) 776-3066
(301) 776-3115

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11153
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
950724800
MD
Enumeration date
04/05/2011
Last updated
04/05/2011
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