MEDICARE: VLADO PAVLOVIC D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10321	KY

General Provider Information

NPI Number	:	1194371112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VLADO PAVLOVIC D.D.S.

Provider Business Mailing Address
First Line	:	844 W HIGH ST UNIT 1
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40508-2514
Country	:	US
Telephone Number	:	740-825-0745
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 COTTINGHAM DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-1626
Country	:	US
Telephone Number	:	513-786-0260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	10/03/2025

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