Provider Demographics
NPI:1093870529
Name:SVILENOV, PAVEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAVEL
Middle Name:
Last Name:SVILENOV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12574 PROMISE CREEK LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-7713
Mailing Address - Country:US
Mailing Address - Phone:317-537-7280
Mailing Address - Fax:
Practice Address - Street 1:12574 PROMISE CREEK LN
Practice Address - Street 2:SUITE 110
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-7713
Practice Address - Country:US
Practice Address - Phone:317-537-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010897A1223G0001X
IL019-0268091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200840410Medicaid