Provider Demographics
NPI:1518006519
Name:PAVLO, JOHN ARTHUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:PAVLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:215 NEWBURY STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2400
Mailing Address - Country:US
Mailing Address - Phone:978-535-5353
Mailing Address - Fax:978-535-1631
Practice Address - Street 1:215 NEWBURY STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2400
Practice Address - Country:US
Practice Address - Phone:978-535-5353
Practice Address - Fax:978-535-1631
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA194731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics