MEDICARE: DR. PAUL JAMES DUFFELL DMD

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	MA14196	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA14196	OTHER	MA	STATE LICENSE

General Provider Information

NPI Number	:	1205878626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL JAMES DUFFELL DMD

Provider Business Mailing Address
First Line	:	31 NOON HILL AVE
Second Line	:
City	:	NORFOLK
State	:	MA
Zip	:	02056-1136
Country	:	US
Telephone Number	:	508-520-6716
Fax Number	:

Provider Business Practice Location Address
First Line	:	456 NEWTONVILLE AVE
Second Line	:
City	:	NEWTONVILLE
State	:	MA
Zip	:	02460-1925
Country	:	US
Telephone Number	:	617-244-4133
Fax Number	:

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	03/11/2010

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