Provider Demographics
NPI:1538716675
Name:IVAN P PASKALEV DMD PC
Entity type:Organization
Organization Name:IVAN P PASKALEV DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASKALEV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-485-0272
Mailing Address - Street 1:2400 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3131
Mailing Address - Country:US
Mailing Address - Phone:541-485-0272
Mailing Address - Fax:541-485-0139
Practice Address - Street 1:2400 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3131
Practice Address - Country:US
Practice Address - Phone:541-485-0272
Practice Address - Fax:541-485-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty