Provider Demographics
NPI:1912588625
Name:BRUCE J. PAVLOV, DDS
Entity Type:Organization
Organization Name:BRUCE J. PAVLOV, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-225-0617
Mailing Address - Street 1:1101 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2622
Mailing Address - Country:US
Mailing Address - Phone:906-225-0617
Mailing Address - Fax:906-225-1777
Practice Address - Street 1:1101 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2622
Practice Address - Country:US
Practice Address - Phone:906-225-0617
Practice Address - Fax:906-225-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty