Healthcare Provider Details

I. General information

NPI: 1700909819
Provider Name (Legal Business Name): WILLIAM D. PAULUS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 S UNION AVE
ALLIANCE OH
44601-4349
US

IV. Provider business mailing address

1604 S UNION AVE
ALLIANCE OH
44601-4349
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-4046
  • Fax: 330-821-0448
Mailing address:
  • Phone: 330-821-4046
  • Fax: 330-821-0448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30-013548
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: