Healthcare Provider Details

I. General information

NPI: 1184742488
Provider Name (Legal Business Name): MATTHEW ANTHONY PAULSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 OLENTANGY RIVER RD STE 500B
COLUMBUS OH
43214-3437
US

IV. Provider business mailing address

3063 ASBURY DR
COLUMBUS OH
43221-2671
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-1110
  • Fax:
Mailing address:
  • Phone: 614-949-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20679
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: