MEDICARE: PAUL E MENTON DDS INC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	25803	TX

General Provider Information

NPI Number	:	1538572961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL E MENTON DDS INC

Provider Business Mailing Address
First Line	:	847 W MITCHELL ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2506
Country	:	US
Telephone Number	:	817-265-3159
Fax Number	:

Provider Business Practice Location Address
First Line	:	847 W MITCHELL ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2506
Country	:	US
Telephone Number	:	817-265-3159
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAUL E MENTON
Credential	:	DDS
Telephone Number	:	817-265-3159

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	03/22/2016

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