Provider Demographics
NPI:1306859814
Name:DAVID ALAN PESAVENTO, DDS, LTD
Entity Type:Organization
Organization Name:DAVID ALAN PESAVENTO, DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PESAVENTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-896-7739
Mailing Address - Street 1:1940 WEST GALENA BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506
Mailing Address - Country:US
Mailing Address - Phone:630-896-7739
Mailing Address - Fax:630-896-7730
Practice Address - Street 1:1940 WEST GALENA BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-896-7739
Practice Address - Fax:630-896-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01914382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty