Provider Demographics
NPI:1215944368
Name:LANTIGUA, KELVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:LANTIGUA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7076 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3860
Mailing Address - Country:US
Mailing Address - Phone:954-964-1494
Mailing Address - Fax:954-964-5195
Practice Address - Street 1:7076 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3860
Practice Address - Country:US
Practice Address - Phone:954-964-1494
Practice Address - Fax:954-964-5195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice