Active NPI
Nick Pavlov, D.D.S.
- General Practice Dentistry
- Vista, CA
National Provider Identifier
1154355741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 44055
- Practice address
- 706 Townsite Dr
Vista, CA 92084-4502 - Phone
- (760) 724-4392
- Fax
- (760) 724-4392
- NPI assigned
- Jul 10, 2006
- Last updated
- Mar 17, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 44055 | CA | Primary |
Addresses
Primary practice location
706 Townsite Dr
Vista, CA 92084-4502
Mailing address
470 Nautilus St
Suite 212
La Jolla, CA 92037-5969
Phone (858) 459-5591
Other practice location 1
470 Nautilus St Ste 212
LA Jolla, CA 92037-5970
Phone (858) 459-5591
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sergio Ayala DDS Inc | General Practice | Past | Accepting new patients |
| Lajolla Cosmetic & Family Dentistry Inc | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- La Jolla, CA
- NPI 1497946933
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1154355741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "470 NAUTILUS ST",
"address_2": "SUITE 212",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920375969",
"telephone_number": "858-459-5591",
"fax_number": "858-459-4242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "706 TOWNSITE DR",
"city": "VISTA",
"state": "CA",
"postal_code": "920844502",
"telephone_number": "760-724-4392",
"fax_number": "760-724-4392"
}
],
"practiceLocations": [
{
"address_1": "470 Nautilus St Ste 212",
"address_purpose": "LOCATION",
"city": "LA Jolla",
"state": "CA",
"postal_code": "920375970",
"country_code": "US",
"telephone_number": "858-459-5591",
"fax_number": "858-459-4242",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PAVLOV",
"first_name": "NICK",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "44055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.