Healthcare Provider Details

I. General information

NPI: 1962525055
Provider Name (Legal Business Name): PAULUS ORTHODONTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/09/2008
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: DR. WILLIAM DAVID PAULUS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 330-821-4046