Provider Demographics
NPI:1235480831
Name:S. JASON PAVLIK
Entity Type:Organization
Organization Name:S. JASON PAVLIK
Other - Org Name:PAVLIK ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:PAVLIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-376-5055
Mailing Address - Street 1:5010 W NEWBERRY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-5212
Mailing Address - Country:US
Mailing Address - Phone:352-376-5055
Mailing Address - Fax:352-376-5054
Practice Address - Street 1:5010 W NEWBERRY RD
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5212
Practice Address - Country:US
Practice Address - Phone:352-376-5055
Practice Address - Fax:352-376-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty