Provider Demographics
NPI:1164312054
Name:LAVIN, MESSALINA (DMD)
Entity type:Individual
Prefix:DR
First Name:MESSALINA
Middle Name:
Last Name:LAVIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17051 FEATHERBED CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9743
Mailing Address - Country:US
Mailing Address - Phone:786-381-2221
Mailing Address - Fax:
Practice Address - Street 1:19521 HIGHLAND OAKS DR STE 301
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9634
Practice Address - Country:US
Practice Address - Phone:239-244-8853
Practice Address - Fax:239-244-1230
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist