Provider Demographics
NPI:1407134679
Name:PAVENTY, TIMOTHY CARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CARL
Last Name:PAVENTY
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 1:2936 YALE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4886
Mailing Address - Country:US
Mailing Address - Phone:702-541-5179
Mailing Address - Fax:
Practice Address - Street 1:992 E US HIGHWAY 80 STE A
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8707
Practice Address - Country:US
Practice Address - Phone:702-541-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist