Provider Demographics
NPI:1023076577
Name:PAVEK, DALE L (DDS)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:L
Last Name:PAVEK
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:USA DENTAC, 1631 WETZEL BLVD
Mailing Address - Street 2:BLDG 815
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-526-5400
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAC, 1631 WETZEL BLVD
Practice Address - Street 2:BLDG 815
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3568-51223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice