Healthcare Provider Details

I. General information

NPI: 1366935637
Provider Name (Legal Business Name): KAVETY DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 E COLORADO BLVD
PASADENA CA
91107-3746
US

IV. Provider business mailing address

231 S DE LACEY AVE UNIT 1005
PASADENA CA
91105-4100
US

V. Phone/Fax

Practice location:
  • Phone: 626-600-7171
  • Fax:
Mailing address:
  • Phone: 630-815-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number59445
License Number StateCA

VIII. Authorized Official

Name: DR. PALLAVI KAVETY
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 630-815-4230