Provider Demographics
NPI:1053565572
Name:PAVICIC, MARIJAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIJAN
Middle Name:
Last Name:PAVICIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIO
Other - Middle Name:
Other - Last Name:PAVICIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:19712 W 130TH ST
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-8435
Mailing Address - Country:US
Mailing Address - Phone:440-878-4444
Mailing Address - Fax:440-238-0939
Practice Address - Street 1:19712 W 130TH ST
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-8435
Practice Address - Country:US
Practice Address - Phone:440-878-4444
Practice Address - Fax:440-238-0939
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH197621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice