Basic Information
| Provider Information | |||||||||
| NPI: | 1013162635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAVLOVICH | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1765 SW PARKWAY DR | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977562550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415488175 | ||||||||
| FaxNumber: | 5413453970 | ||||||||
| Practice Location | |||||||||
| Address1: | 1765 SW PARKWAY DR | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415488175 | ||||||||
| FaxNumber: | 5413453970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2008 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D10918 | OR | Y | Dental Providers | Dentist | General Practice |
No ID Information.