Provider Demographics
NPI:1366641268
Name:PAVONE, SALVATORE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:
Last Name:PAVONE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13340 131ST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3804
Mailing Address - Country:US
Mailing Address - Phone:718-529-3800
Mailing Address - Fax:718-529-1761
Practice Address - Street 1:13340 131ST ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3804
Practice Address - Country:US
Practice Address - Phone:718-529-3800
Practice Address - Fax:718-529-1761
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052627-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist