MEDICARE: DR. HAYLEY HECKMAN PAVLOV D.M.D., M.S.D.

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	1223P0221X	Pediatric Dentistry	12010602A	IN

General Provider Information

NPI Number	:	1730298571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAYLEY HECKMAN PAVLOV D.M.D., M.S.D.

Provider Business Mailing Address
First Line	:	3158 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3170
Country	:	US
Telephone Number	:	812-376-0166
Fax Number	:	812-376-0166

Provider Business Practice Location Address
First Line	:	3158 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3170
Country	:	US
Telephone Number	:	812-376-0166
Fax Number	:	812-376-0166

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/09/2007

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