Provider Demographics
NPI:1740510122
Name:PAVELKA, THOMAS GENE (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GENE
Last Name:PAVELKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:EIGHTY FOUR
Mailing Address - State:PA
Mailing Address - Zip Code:15330-0071
Mailing Address - Country:US
Mailing Address - Phone:724-229-4252
Mailing Address - Fax:
Practice Address - Street 1:30 MONONGAHELA PIKE
Practice Address - Street 2:
Practice Address - City:EIGHTY FOUR
Practice Address - State:PA
Practice Address - Zip Code:15330
Practice Address - Country:US
Practice Address - Phone:724-229-4252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA021976-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice