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General NPI Number Information
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NPI Number | 1073833059
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Entity Type | Organization
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Legal Business Name | PAVON FAMILY DENTISTRY P.S.C.
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 465 N 26TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40212-1449
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Country | US
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Telephone | 502-778-7767
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Fax | 502-778-7677
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Provider Business Mailing Address
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Address Line | 3600 GLENFIELD CT
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City | LOUISVILLE
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State | KY
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Zip | 40241-2513
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Country | US
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Telephone | 502-326-0789
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Fax | 502-425-0349
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HUGO PAVON
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Credential | D.M.D.
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Telephone | 502-326-0789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6711
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License Number State | KY
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