Provider Demographics
NPI:1992827075
Name:PAVLOV, ARKADY (DDS)
Entity Type:Individual
Prefix:
First Name:ARKADY
Middle Name:
Last Name:PAVLOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 OCEAN PKWY
Mailing Address - Street 2:SUITE L1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7747
Mailing Address - Country:US
Mailing Address - Phone:718-769-1001
Mailing Address - Fax:718-648-3143
Practice Address - Street 1:2610 OCEAN PKWY
Practice Address - Street 2:SUITE L1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7747
Practice Address - Country:US
Practice Address - Phone:718-769-1001
Practice Address - Fax:718-648-3143
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01360049Medicaid