Active NPI
Vani Pavan, PERIODONTIST
- Periodontics
- Marlin, TX
National Provider Identifier
1053657494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 28582
- Practice address
- 110 Church St
Marlin, TX 76661-2809 - Phone
- (972) 670-4991
- NPI assigned
- Dec 12, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 28582 | TX | Primary |
Addresses
Primary practice location
110 Church St
Marlin, TX 76661-2809
Mailing address
2805 E Grapevine Mills Cir
Suite 108
Grapevine, TX 76051-1210
Phone (972) 355-8688
Other practice location 1
2805 E Grapevine Mills Cir
Suite 108
Grapevine, TX 76051-1210
Phone (972) 355-8688
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205490257 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2025 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584403200000",
"number": "1053657494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2805 E GRAPEVINE MILLS CIR",
"address_2": "SUITE 108",
"city": "GRAPEVINE",
"state": "TX",
"postal_code": "760511210",
"telephone_number": "972-355-8688",
"fax_number": "972-539-8389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 CHURCH ST",
"city": "MARLIN",
"state": "TX",
"postal_code": "766612809",
"telephone_number": "972-670-4991"
}
],
"practiceLocations": [
{
"address_1": "2805 E Grapevine Mills Cir",
"address_2": "SUITE 108",
"address_purpose": "LOCATION",
"city": "Grapevine",
"state": "TX",
"postal_code": "760511210",
"country_code": "US",
"telephone_number": "972-355-8688",
"fax_number": "972-539-8389",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PAVAN",
"first_name": "VANI",
"credential": "PERIODONTIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-12",
"last_updated": "2020-03-17",
"certification_date": "2020-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "28582",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1205490257",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marlin, TX
- Marlin Nursing and Rehab Center LLC
- Sarah Mason, LPC
- Earlletha Milton
- Nurse-Con Corporation (Elmwood Nursing Center)
- Eric Roy Odling, LP
- Providence Health Services of Waco (Falls Community Health Center)
- Jeremy Reynolds, PA-C
- Jill Andrea Riley, LCSW
- Stephanie Rodrigues, LPC
- George Glenn Rose, DDS DOS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.