Provider Demographics
NPI:1801900303
Name:PAVLUSHKIN, ALLA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:PAVLUSHKIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:RAFTERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2515 HWY 516
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857
Mailing Address - Country:US
Mailing Address - Phone:732-607-0909
Mailing Address - Fax:732-607-7555
Practice Address - Street 1:2515 HWY 516
Practice Address - Street 2:UNIT 2A EMPIRE DENTAL PC
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:732-607-0909
Practice Address - Fax:732-607-7555
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI192711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice