Active NPI
Mitali C Lavani, DDS
- Dentist
- Indian Land, SC
National Provider Identifier
1912784471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10658
- Practice address
- 9709 Redstone Dr Ste 500
Indian Land, SC 29707-5402 - Phone
- (803) 753-1349
- NPI assigned
- Sep 11, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10658 | SC | Primary |
| Dentist | 122300000X | 13429 | NC |
Addresses
Primary practice location
9709 Redstone Dr Ste 500
Indian Land, SC 29707-5402
Mailing address
1420 Reidhaven St
Matthews, NC 28105-7727
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13429 | NC | MD | Dentist |
| 10658 | SC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696291200000",
"number": "1912784471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 REIDHAVEN ST",
"city": "MATTHEWS",
"state": "NC",
"postal_code": "281057727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9709 REDSTONE DR STE 500",
"city": "INDIAN LAND",
"state": "SC",
"postal_code": "297075402",
"telephone_number": "803-753-1349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVANI",
"first_name": "MITALI",
"middle_name": "C",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-11",
"last_updated": "2023-10-03",
"certification_date": "2023-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "10658",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "13429",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indian Land, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.