Provider Demographics
NPI:1588891881
Name:PAVENTY, JOSEPH L (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:PAVENTY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22106 E COUNTRY VISTA DR STE C
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-6017
Mailing Address - Country:US
Mailing Address - Phone:509-381-4200
Mailing Address - Fax:
Practice Address - Street 1:22106 E COUNTRY VISTA DR STE C
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6017
Practice Address - Country:US
Practice Address - Phone:509-381-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60791223X0400X
WADE601914581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics