1871859256 NPI number — KATHERINE S. PAVILA PRIMARY DENTAL HEALT

Table of content: KATHERINE S. PAVILA PRIMARY DENTAL HEALT (NPI 1871859256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871859256 NPI number — KATHERINE S. PAVILA PRIMARY DENTAL HEALT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAVILA
Provider First Name:
KATHERINE
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PRIMARY DENTAL HEALT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871859256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 528
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHEL
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99559-0528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-543-6229
Provider Business Mailing Address Fax Number:
907-543-6393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CLINIC WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNTUTLIAK
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-256-2718
Provider Business Practice Location Address Fax Number:
907-256-2718
Provider Enumeration Date:
04/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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