Organization
PAVON FAMILY DENTISTRY P.S.C.
Active
Parent organization
PAVON FAMILY DENTISTRY P.S.C.
Other names
Portland Dental Center and Broadway Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
PAVON FAMILY DENTISTRY P.S.C.
Authorized official
DR. HUGO PAVON D.M.D. (PRESIDENT)
(502) 326-0789
Entity
Organization
Contact information
Practice address
465 N 26TH ST, LOUISVILLE, KY 40212-1449
(502) 778-7767
(502) 778-7677
Mailing address
3600 GLENFIELD CT, LOUISVILLE, KY 40241-2513
(502) 326-0789
(502) 425-0349
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6711
KY
Other
Enumeration date
06/01/2010
Last updated
06/01/2010
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