Provider Demographics
NPI:1326724493
Name:VICTOR PAVLYCH DDS LTD DBA COMPREHENSIVE DENTAL & IMPLANT CENTER
Entity Type:Organization
Organization Name:VICTOR PAVLYCH DDS LTD DBA COMPREHENSIVE DENTAL & IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLYCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-840-0340
Mailing Address - Street 1:7064 W BELMONT AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4600
Mailing Address - Country:US
Mailing Address - Phone:773-840-0340
Mailing Address - Fax:773-257-7009
Practice Address - Street 1:7064 W BELMONT AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4600
Practice Address - Country:US
Practice Address - Phone:773-840-0340
Practice Address - Fax:773-257-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty