Provider Demographics
NPI:1487318416
Name:ZOLA DENTAL PORTLAND LLC, DR. ANTHONY PAVENTY,DMD
Entity type:Organization
Organization Name:ZOLA DENTAL PORTLAND LLC, DR. ANTHONY PAVENTY,DMD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YESENOFSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-646-1931
Mailing Address - Street 1:8285 SW NIMBUS AVE STE 185
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6465
Mailing Address - Country:US
Mailing Address - Phone:503-646-1931
Mailing Address - Fax:503-520-1205
Practice Address - Street 1:8285 SW NIMBUS AVE STE 185
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6465
Practice Address - Country:US
Practice Address - Phone:503-646-1931
Practice Address - Fax:503-520-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental