MEDICARE: DR. PAUL EDWARD MENTON D.D.S.

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)	8207	TX

General Provider Information

NPI Number	:	1548328222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL EDWARD MENTON D.D.S.

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	:	817-261-1968

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	:	817-261-1968

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/09/2007

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