Individual
DR. LAVANYA VENKATESWARAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
44 LISPENARD ST, SUITE A, NEW YORK, NY 10013-2550
(212) 473-4444
Mailing address
22 AVE AT PORT IMPERIAL, APT 524, WEST NEW YORK, NJ 07093-7800
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
055973-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055973-1
NY STATE DENTAL LICENSE
NY
Enumeration date
09/03/2008
Last updated
03/26/2013
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