Provider Demographics
NPI:1659043214
Name:PAVLIDAKEY, VIKTOR (DMD)
Entity type:Individual
Prefix:
First Name:VIKTOR
Middle Name:
Last Name:PAVLIDAKEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 CANDLER RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2301
Mailing Address - Country:US
Mailing Address - Phone:727-366-2621
Mailing Address - Fax:
Practice Address - Street 1:870 SAXON BLVD STE 39
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8209
Practice Address - Country:US
Practice Address - Phone:386-200-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN264661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice