Healthcare Provider Details

I. General information

NPI: 1790139749
Provider Name (Legal Business Name): TIMOTHY SCOTT PAULSON JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 6TH ST
WILLIAMS AZ
86046-0110
US

IV. Provider business mailing address

PO BOX 3630
FLAGSTAFF AZ
86003-3630
US

V. Phone/Fax

Practice location:
  • Phone: 928-635-4441
  • Fax:
Mailing address:
  • Phone: 928-522-9879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number122300000
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: