MEDICARE: DR. PAUL EDWARD GAUTHIER D.D.S., P. A.

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	7909	MD

General Provider Information

NPI Number	:	1407853278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL EDWARD GAUTHIER D.D.S., P. A.

Provider Business Mailing Address
First Line	:	65 THOMAS JOHNSON DR
Second Line	:	SUITE B
City	:	FREDERICK
State	:	MD
Zip	:	21702-4371
Country	:	US
Telephone Number	:	301-698-0044
Fax Number	:	301-698-1440

Provider Business Practice Location Address
First Line	:	65 THOMAS JOHNSON DR
Second Line	:	SUITE B
City	:	FREDERICK
State	:	MD
Zip	:	21702-4371
Country	:	US
Telephone Number	:	301-698-0044
Fax Number	:	301-698-1440

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/09/2007

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