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General NPI Number Information
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NPI Number | 1710018882
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Entity Type | Organization
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Legal Business Name | DR. PAULA S. CRUM, S.C.
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2581 DEVELOPMENT DR SUITE 204
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City | GREEN BAY
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State | WI
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Zip | 54311-4247
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Country | US
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Telephone | 920-347-2640
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Fax | 920-347-2641
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Provider Business Mailing Address
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Address Line | 2581 DEVELOPMENT DR SUITE 204
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City | GREEN BAY
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State | WI
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Zip | 54311-4247
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Country | US
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Telephone | 920-347-2640
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Fax | 920-347-2641
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAULA S. CRUM
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Credential | D.D.S., M.S.
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Telephone | 920-347-2640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 3119
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License Number State | WI
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