Provider Demographics
NPI:1417152059
Name:EDWARD J PAVLIK DDS & ASSOC LTD
Entity Type:Organization
Organization Name:EDWARD J PAVLIK DDS & ASSOC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAVLIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-464-6465
Mailing Address - Street 1:21128 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:815-464-6465
Mailing Address - Fax:815-464-6479
Practice Address - Street 1:2555 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-747-9300
Practice Address - Fax:708-747-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty