William A. Pavlat, DDS
Individual provider Active NPI General Practice Dentistry · Granger, TX
NPI 1801909783 · NPPES record last updated Oct 26, 2011
Key facts
- NPI
- 1801909783
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12,047 (TX)
- Practice address
- 101 E. Davilla
Granger, TX 76530 - Phone
- (512) 859-2424
- Fax
- (512) 859-2425
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 11, 2016 through Feb 11, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12047 | TX | MD | Addiction (Substance Use Disorder) Counselor |
| 12,047 | TX | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12,047 | TX | Yes |
Addresses
Primary practice location
101 E. Davilla
Granger, TX 76530
Mailing address
PO Box 278
Granger, TX 76530-0278
Phone (512) 859-2424
Other providers in Granger, TX
All providers in Granger, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.