Provider Demographics
NPI:1346677200
Name:AVALON DENTAL, LLC
Entity Type:Organization
Organization Name:AVALON DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAIROT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-277-2860
Mailing Address - Street 1:101 HEAVENSGATE RD
Mailing Address - Street 2:E
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-1100
Mailing Address - Country:US
Mailing Address - Phone:386-277-2860
Mailing Address - Fax:
Practice Address - Street 1:101 HEAVENSGATE RD
Practice Address - Street 2:E
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-1100
Practice Address - Country:US
Practice Address - Phone:386-277-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12941261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental