Healthcare Provider Details

I. General information

NPI: 1932371184
Provider Name (Legal Business Name): PAUL DOUGLAS SCHWARZ DMD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 RICHMOND ST
EL SEGUNDO CA
90245-2228
US

IV. Provider business mailing address

538 RICHMOND ST
EL SEGUNDO CA
90245-2228
US

V. Phone/Fax

Practice location:
  • Phone: 702-372-4073
  • Fax: 702-361-6291
Mailing address:
  • Phone: 702-372-4073
  • Fax: 702-361-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberCS1172
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number100527
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5543
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number100527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: