Provider Demographics
NPI:1184348724
Name:PAVLOS, GREGORY STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEPHEN
Last Name:PAVLOS
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 1:2697 ALDONZA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3418
Mailing Address - Country:US
Mailing Address - Phone:916-505-3181
Mailing Address - Fax:
Practice Address - Street 1:2697 ALDONZA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3418
Practice Address - Country:US
Practice Address - Phone:916-505-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7709TU122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist