Provider Demographics
NPI:1194371112
Name:PAVLOVIC, VLADO (DDS)
Entity Type:Individual
Prefix:
First Name:VLADO
Middle Name:
Last Name:PAVLOVIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 WEST HIGH ST. UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508
Mailing Address - Country:US
Mailing Address - Phone:226-246-9585
Mailing Address - Fax:
Practice Address - Street 1:16005 US-23
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129
Practice Address - Country:US
Practice Address - Phone:606-739-0403
Practice Address - Fax:606-739-0405
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice