Provider Demographics
NPI:1184790115
Name:VASILIOS BILL J PAVLAKOS DDS PC
Entity type:Organization
Organization Name:VASILIOS BILL J PAVLAKOS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VASILIOS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PAVLAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-292-7526
Mailing Address - Street 1:3904 JUAN TABO NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-292-7526
Mailing Address - Fax:505-292-1058
Practice Address - Street 1:3904 JUAN TABO NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-292-7526
Practice Address - Fax:505-292-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM681068OtherUNITED CONCORDIA PROVIDER
NM008676OtherBCBS PROVIDER #