Provider Demographics
NPI:1285947929
Name:LAVIGNE, COURTNEY LIN (DMD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LIN
Last Name:LAVIGNE
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 1:234 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2407
Mailing Address - Country:US
Mailing Address - Phone:401-225-6399
Mailing Address - Fax:
Practice Address - Street 1:234 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2407
Practice Address - Country:US
Practice Address - Phone:401-225-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDEN030811223G0001X
MADN1856353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice