Provider Demographics
NPI:1366538142
Name:PAVONE, ANTHONY GEORGE (DDS MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GEORGE
Last Name:PAVONE
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2 MEDICAL PARK DR STE 6
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1966
Mailing Address - Country:US
Mailing Address - Phone:845-675-8008
Mailing Address - Fax:845-675-8010
Practice Address - Street 1:2 MEDICAL PARK DR STE 6
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1966
Practice Address - Country:US
Practice Address - Phone:845-675-8008
Practice Address - Fax:845-675-8010
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY04913911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2366611OtherMEDICAL LICENSE
NY0491391OtherDENTAL LICENSE