Provider Demographics
NPI:1518026335
Name:PAVLIK, KENDRA RUTH (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:RUTH
Last Name:PAVLIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 EASTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1981
Mailing Address - Country:US
Mailing Address - Phone:402-562-7775
Mailing Address - Fax:402-564-1818
Practice Address - Street 1:2670 33RD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1315
Practice Address - Country:US
Practice Address - Phone:402-564-7575
Practice Address - Fax:402-564-1818
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE65331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025277900Medicaid