Provider Demographics
NPI:1194722355
Name:LAVORATA, CARL E (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:E
Last Name:LAVORATA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PINE ST
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4811
Mailing Address - Country:US
Mailing Address - Phone:631-864-3814
Mailing Address - Fax:
Practice Address - Street 1:1036 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3208
Practice Address - Country:US
Practice Address - Phone:631-543-4433
Practice Address - Fax:631-543-2540
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0409601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice