Provider Demographics
NPI:1710502125
Name:DRS PAVLIK AND BARGEN DDS PC
Entity Type:Organization
Organization Name:DRS PAVLIK AND BARGEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-920-0959
Mailing Address - Street 1:3611 27TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2397
Mailing Address - Country:US
Mailing Address - Phone:402-564-7575
Mailing Address - Fax:402-564-1818
Practice Address - Street 1:3611 27TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2397
Practice Address - Country:US
Practice Address - Phone:402-564-7575
Practice Address - Fax:402-564-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty