Provider Demographics
NPI:1689746497
Name:PAVLAKOS, VASILIOS JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:VASILIOS
Middle Name:JAMES
Last Name:PAVLAKOS
Suffix:
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 1:3904 JUAN TABO NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-292-7526
Mailing Address - Fax:505-292-1058
Practice Address - Street 1:3904 JUAN TABO NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-292-7526
Practice Address - Fax:505-292-1058
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM681068OtherUNITED CONCORDIA PROVIDER
NM008676OtherBCBS PROVIDER #