# PAVON FAMILY DENTISTRY P.S.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PAVON FAMILY DENTISTRY P.S.C.
- **Other names:** Portland Dental Center and Broadway Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073833059
- **Legal business name:** PAVON FAMILY DENTISTRY P.S.C.
- **Authorized official:** DR. HUGO PAVON D.M.D. (PRESIDENT)
- **Authorized official phone:** (502) 326-0789

## Contact information

- **Practice address:** 465 N 26TH ST, LOUISVILLE, KY 40212-1449
- **Practice address phone:** (502) 778-7767
- **Practice address fax:** (502) 778-7677
- **Mailing address:** 3600 GLENFIELD CT, LOUISVILLE, KY 40241-2513
- **Mailing address phone:** (502) 326-0789
- **Mailing address fax:** (502) 425-0349

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6711 | KY | Yes |

## Other

- **Enumeration date:** 06/01/2010
- **Last updated:** 06/01/2010