Provider Demographics
NPI:1013134212
Name:PAWLUS DENTAL INC
Entity Type:Organization
Organization Name:PAWLUS DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAWLUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-372-8590
Mailing Address - Street 1:4001 W GOELLER BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-8309
Mailing Address - Country:US
Mailing Address - Phone:812-372-8590
Mailing Address - Fax:812-372-8934
Practice Address - Street 1:4001 W GOELLER BLVD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8309
Practice Address - Country:US
Practice Address - Phone:812-372-8590
Practice Address - Fax:812-372-8934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009682A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20-0610195OtherTAX ID NUMBER