Provider Demographics
NPI:1700845930
Name:PAVELKA, ROBERT JASON (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JASON
Last Name:PAVELKA
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:400 S COTTONWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5708
Mailing Address - Country:US
Mailing Address - Phone:972-231-6661
Mailing Address - Fax:972-231-3161
Practice Address - Street 1:400 S COTTONWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5708
Practice Address - Country:US
Practice Address - Phone:972-231-6661
Practice Address - Fax:972-231-3161
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX193461223S0112X
TXL88831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery