Individual
VANI PAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PERIODONTIST
Contact information
Practice address
110 CHURCH ST, MARLIN, TX 76661-2809
(972) 670-4991
Mailing address
2805 E GRAPEVINE MILLS CIR, SUITE 108, GRAPEVINE, TX 76051-1210
(972) 355-8688
(972) 539-8389
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
28582
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205490257
—
TX
Enumeration date
12/12/2012
Last updated
03/17/2020
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