Provider Demographics
NPI:1891450185
Name:ZOLA DENTAL RALEIGH PARK LLC, DR. ANTHONY PAVENTY DMD
Entity Type:Organization
Organization Name:ZOLA DENTAL RALEIGH PARK LLC, DR. ANTHONY PAVENTY DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-292-6773
Mailing Address - Street 1:8568 SW APPLE WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1772
Mailing Address - Country:US
Mailing Address - Phone:503-292-6773
Mailing Address - Fax:503-292-6773
Practice Address - Street 1:8568 SW APPLE WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1772
Practice Address - Country:US
Practice Address - Phone:503-292-6773
Practice Address - Fax:503-292-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental