Organization
ZOLA DENTAL MEDFORD LLC
Active
Other names
Boldt Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY MARK PAVENTY DMD (OWNER)
(509) 475-5367
Entity
Organization
Contact information
Practice address
922 E MAIN, MEDFORD, OR 97504
(509) 475-5367
Mailing address
922 E MAIN ST, MEDFORD, OR 97504-7136
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9209
OR
Other
Enumeration date
04/19/2018
Last updated
04/19/2018
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