Provider Demographics
NPI:1871220475
Name:JAGTIANI, LAVINA (DDS)
Entity type:Individual
Prefix:DR
First Name:LAVINA
Middle Name:
Last Name:JAGTIANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 NW 23RD TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8429
Mailing Address - Country:US
Mailing Address - Phone:650-339-9816
Mailing Address - Fax:
Practice Address - Street 1:2161 E COMMERCIAL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3810
Practice Address - Country:US
Practice Address - Phone:954-687-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist