Individual
MITALI C LAVANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
9709 REDSTONE DR STE 500, INDIAN LAND, SC 29707-5402
(803) 753-1349
Mailing address
1420 REIDHAVEN ST, MATTHEWS, NC 28105-7727
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10658
SC
122300000X
Dentist
13429
NC
Other
Enumeration date
09/11/2023
Last updated
10/03/2023
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