Provider Demographics
NPI:1942489570
Name:DRS. PAVLICK AND REPPAS, INC.
Entity Type:Organization
Organization Name:DRS. PAVLICK AND REPPAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAVLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:330-678-6564
Mailing Address - Street 1:571 BOSTON MILLS RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1164
Mailing Address - Country:US
Mailing Address - Phone:330-655-9700
Mailing Address - Fax:330-342-9847
Practice Address - Street 1:571 BOSTON MILLS RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1164
Practice Address - Country:US
Practice Address - Phone:330-655-9700
Practice Address - Fax:330-342-9847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.065469204E00000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0743902OtherPTAN
OHF62939Medicare UPIN
OH9341791Medicare PIN