Provider Demographics
NPI:1134432586
Name:PAVALUNAS, ROBERT MERRITT (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MERRITT
Last Name:PAVALUNAS
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 1:701 M ST NE STE 104
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4500
Mailing Address - Country:US
Mailing Address - Phone:253-833-9063
Mailing Address - Fax:
Practice Address - Street 1:701 M ST NE STE 104
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4500
Practice Address - Country:US
Practice Address - Phone:253-833-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist