Konstantin Pavolotsky, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

30 020384 Issued in OH

Practice address

6028 Mayfield Rd
Suite 8
Mayfield Heights, OH 44124

Phone

(440) 684-9424

Fax

(440) 684-0126

NPI assigned

Aug 4, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407864259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6028 MAYFIELD RD",
            "address_2": "SUITE 8",
            "city": "MAYFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "44124",
            "telephone_number": "440-684-9424",
            "fax_number": "440-684-0126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6028 MAYFIELD RD",
            "address_2": "SUITE 8",
            "city": "MAYFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "44124",
            "telephone_number": "440-684-9424",
            "fax_number": "440-684-0126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVOLOTSKY",
        "first_name": "KONSTANTIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30 020384",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009774A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0194178",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Mayfield Heights, OH
• Providers in Mayfield Heights, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.