Healthcare Provider Details

I. General information

NPI: 1598914749
Provider Name (Legal Business Name): ASHLEY LYNN PAULUS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE RB&C SUITE 1200 MAILSTOP 6018
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

2625 GRADWOHL RD
TOLEDO OH
43617-1501
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3080
  • Fax: 216-844-3086
Mailing address:
  • Phone: 419-344-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30-022853
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: