Provider Demographics
NPI:1730298571
Name:PAVLOV, HAYLEY HECKMAN (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:HAYLEY
Middle Name:HECKMAN
Last Name:PAVLOV
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3158 N NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3170
Mailing Address - Country:US
Mailing Address - Phone:812-376-0166
Mailing Address - Fax:812-376-0166
Practice Address - Street 1:3158 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3170
Practice Address - Country:US
Practice Address - Phone:812-376-0166
Practice Address - Fax:812-376-0166
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010602A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry