Healthcare Provider Details

I. General information

NPI: 1649700725
Provider Name (Legal Business Name): PAUL PUMILIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 GLORIA DR STE 400
MOSS BLUFF LA
70611-5055
US

IV. Provider business mailing address

4641 APRICOT ST
METAIRIE LA
70001-2408
US

V. Phone/Fax

Practice location:
  • Phone: 337-429-5057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6793
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: