Provider Demographics
NPI:1871859256
Name:PAVILA, KATHERINE S (PRIMARY DENTAL HEALT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:PAVILA
Suffix:
Gender:F
Credentials:PRIMARY DENTAL HEALT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 528
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-6229
Mailing Address - Fax:907-543-6393
Practice Address - Street 1:100 CLINIC WAY
Practice Address - Street 2:
Practice Address - City:TUNTUTLIAK
Practice Address - State:AK
Practice Address - Zip Code:99680
Practice Address - Country:US
Practice Address - Phone:907-256-2718
Practice Address - Fax:907-256-2718
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other