Provider Demographics
NPI:1447412457
Name:PAVLETICH, JOSEPH ANTHONY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:PAVLETICH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13435 WATERTOWN PLANK RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2201
Mailing Address - Country:US
Mailing Address - Phone:262-786-4348
Mailing Address - Fax:
Practice Address - Street 1:13435 WATERTOWN PLANK RD
Practice Address - Street 2:SUITE #1
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2201
Practice Address - Country:US
Practice Address - Phone:262-786-4348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3862WI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist