Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN26466 | FL |
NPI | 1659043214 |
---|---|
Provider Name | Viktor Pavlidakey |
First Address | Clearwater, FL 33765-2301 |
Second Address | Lithia, FL 33547-3835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2021 |
Last Update Date | 01/10/2021 |