Healthcare Provider Details

I. General information

NPI: 1750584173
Provider Name (Legal Business Name): ROY E. PAULSON JR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N. KENWOOD ST.
CASPER WY
82601-2724
US

IV. Provider business mailing address

102 N. KENWOOD ST.
CASPER WY
82601-2724
US

V. Phone/Fax

Practice location:
  • Phone: 307-266-1997
  • Fax: 307-237-4424
Mailing address:
  • Phone: 307-266-1997
  • Fax: 307-237-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ROY EDWARD PAULSON
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 307-266-1997