Provider Demographics
NPI:1902962848
Name:PAVLISIN, MICHELE LAUX (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LAUX
Last Name:PAVLISIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3512
Mailing Address - Country:US
Mailing Address - Phone:909-625-4101
Mailing Address - Fax:
Practice Address - Street 1:601 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3512
Practice Address - Country:US
Practice Address - Phone:909-625-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0191921223G0001X
CA599501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice