Provider Demographics
NPI:1023194875
Name:PROSSER, PAUL J III (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:PROSSER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 CAREA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21161-8960
Mailing Address - Country:US
Mailing Address - Phone:410-692-9474
Mailing Address - Fax:
Practice Address - Street 1:781 FAR HILLS DR
Practice Address - Street 2:SUITE 500
Practice Address - City:NEW FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:17349-8447
Practice Address - Country:US
Practice Address - Phone:717-235-8234
Practice Address - Fax:717-235-8266
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025652L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice