Provider Demographics
NPI:1003149287
Name:GAVRILOV, ALEKSANDAR TODOROV (DDS)
Entity type:Individual
Prefix:
First Name:ALEKSANDAR
Middle Name:TODOROV
Last Name:GAVRILOV
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 1:12920 W PARMER LN STE 101
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7635
Mailing Address - Country:US
Mailing Address - Phone:512-410-7774
Mailing Address - Fax:
Practice Address - Street 1:901 CRYSTAL FALLS PKWY STE 205
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1934
Practice Address - Country:US
Practice Address - Phone:512-379-0193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-07
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24993122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist