Miro A Pavelka, DDS, MSD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D11521 Issued in TX

Practice address

400 S Cottonwood Dr
Suite B
Richardson, TX 75080-5708

Phone

(972) 231-6661

Fax

(972) 231-3161

NPI assigned

Mar 21, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Richardson Oral & Maxillofacial Surgery Associates, Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Richardson, TX
  • NPI 1760497291
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1154447415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S COTTONWOOD DR",
            "address_2": "SUITE B",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750805708",
            "telephone_number": "972-231-6661",
            "fax_number": "972-231-3161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S COTTONWOOD DR",
            "address_2": "SUITE B",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750805708",
            "telephone_number": "972-231-6661",
            "fax_number": "972-231-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVELKA",
        "first_name": "MIRO",
        "middle_name": "A",
        "credential": "DDS, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "D11521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Meier Day Program, Inc.
• Craig Harold Paul, MD
• Robert Keith Paul, OTR
• Jacob Pavel
• Laura Marie Pavelka, ANP-C
• Robert Jason Pavelka, D.D.S., M.D.
• Rebecca Anne Pawley Downey, LPC, LMFT
• Sydney Pawlichuk
• Cameron Anne Payne
• PC Ipa, LLC

• Oral and Maxillofacial Surgery (Dentist) in Richardson, TX
• Providers in Richardson, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.