| NPI | 1073833059 |
|---|---|
| Doing Business As | PORTLAND DENTAL CENTER AND BROADWAY DENTAL |
| Entity Type | Organization |
| Authorized Contact | HUGO PAVON President 502-326-0789 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 6711) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2010-06-01 |