=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720311418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAREN M DEPAOLI, DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2009
-----------------------------------------------------
Last Update Date | 09/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1321 N HARBOR BLVD SUITE 100
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-441-2372
-----------------------------------------------------
Fax | 714-441-2117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1321 N HARBOR BLVD SUITE 100
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-441-2372
-----------------------------------------------------
Fax | 714-441-2117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KAREN M DEPAOLI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 714-441-2372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 40928
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------