Basic Information
| Provider Information | |||||||||
| NPI: | 1003149287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAVRILOV | ||||||||
| FirstName: | ALEKSANDAR | ||||||||
| MiddleName: | TODOROV | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12920 W PARMER LN STE 101 | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786137635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124107774 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 901 CRYSTAL FALLS PKWY STE 205 | ||||||||
| Address2: | |||||||||
| City: | LEANDER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786411934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123790193 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2009 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 24993 | TX | N | Dental Providers | Dentist | 1223G0001X | 24993 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.