Healthcare Provider Details

I. General information

NPI: 1265056881
Provider Name (Legal Business Name): PARADISE DENTAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WAKINS BLDG. 125 MIDDLE RD. GUALO RAI
SAIPAN MP
96950-8201
US

IV. Provider business mailing address

PO BOX 10001
SAIPAN MP
96950-8901
US

V. Phone/Fax

Practice location:
  • Phone: 670-789-8201
  • Fax: 670-488-1044
Mailing address:
  • Phone: 670-234-4040
  • Fax: 670-488-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NELSON C KRUM JR.
Title or Position: MANAGING DENTIST
Credential: DDS
Phone: 670-234-4040