Provider Demographics
NPI:1649583931
Name:KAVETY, PALLAVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:
Last Name:KAVETY
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 1:3500 S BRISTOL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7319
Mailing Address - Country:US
Mailing Address - Phone:630-815-4230
Mailing Address - Fax:
Practice Address - Street 1:3500 S BRISTOL ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7319
Practice Address - Country:US
Practice Address - Phone:630-815-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59445122300000X
MDLL6091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid