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General NPI Number Information
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NPI Number | 1306859814
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Entity Type | Organization
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Legal Business Name | DAVID ALAN PESAVENTO, DDS, LTD
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1940 WEST GALENA BLVD SUITE 6
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City | AURORA
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State | IL
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Zip | 60506
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Country | US
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Telephone | 630-896-7739
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Fax | 630-896-7730
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Provider Business Mailing Address
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Address Line | 1940 WEST GALENA BLVD SUITE 6
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City | AURORA
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State | IL
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Zip | 60506
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Country | US
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Telephone | 630-896-7739
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Fax | 630-896-7730
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Authorized Official
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Title or Position | DENTIST/ORTHODONTIST
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Name | DAVID ALAN PESAVENTO
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Credential | DDS
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Telephone | 630-896-7739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 01914382
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License Number State | IL
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