Organization
VASILIOS BILL J PAVLAKOS DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VASILIOS JAMES PAVLAKOS DDS (DOCTOR OWNER)
(505) 292-7526
Entity
Organization
Contact information
Practice address
3904 JUAN TABO NE, ALBUQUERQUE, NM 87111
(505) 292-7526
(505) 292-1058
Mailing address
3904 JUAN TABO NE, ALBUQUERQUE, NM 87111
(505) 292-7526
(505) 292-1058
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1448
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008676
BCBS PROVIDER #
NM
01
—
681068
UNITED CONCORDIA PROVIDER
NM
Enumeration date
11/28/2006
Last updated
08/22/2020
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