Provider Demographics
NPI:1588901383
Name:PAWLOSKI, GRETCHEN NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:NICOLE
Last Name:PAWLOSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11132 BROAD RIVER RD
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11132 BROAD RIVER RD
Practice Address - Street 2:SUITE A AND B
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9668
Practice Address - Country:US
Practice Address - Phone:740-350-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice