MEDICARE: PAUL J PROSSER III DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS025652L	PA

General Provider Information

NPI Number	:	1023194875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J PROSSER III DDS

Provider Business Mailing Address
First Line	:	4855 CAREA RD
Second Line	:
City	:	WHITE HALL
State	:	MD
Zip	:	21161-8960
Country	:	US
Telephone Number	:	410-692-9474
Fax Number	:

Provider Business Practice Location Address
First Line	:	781 FAR HILLS DR
Second Line	:	SUITE 500
City	:	NEW FREEDOM
State	:	PA
Zip	:	17349-8447
Country	:	US
Telephone Number	:	717-235-8234
Fax Number	:	717-235-8266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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