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General NPI Number Information
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NPI Number | 1497892210
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Entity Type | Organization
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Legal Business Name | PARAGON DENTAL PC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 1221 GOLDEN GATE DR
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City | PAPILLION
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State | NE
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Zip | 68046-2837
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Country | US
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Telephone | 402-331-2070
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Fax | 402-331-2186
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Provider Business Mailing Address
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Address Line | 1221 GOLDEN GATE DR
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City | PAPILLION
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State | NE
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Zip | 68046-2837
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Country | US
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Telephone | 402-331-2070
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Fax | 402-331-2186
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Authorized Official
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Title or Position | PRESIDENT AND DENTIST
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Name | DR. MATTHEW D CARTER
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Credential | DDS
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Telephone | 402-331-2070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6346
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License Number State | NE
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