Provider Demographics
NPI:1073700852
Name:PAULUS, MARCUS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:L
Last Name:PAULUS
Suffix:
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:PO BOX 3756
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-3756
Mailing Address - Country:US
Mailing Address - Phone:586-393-1516
Mailing Address - Fax:586-393-1518
Practice Address - Street 1:8292 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2737
Practice Address - Country:US
Practice Address - Phone:586-393-1516
Practice Address - Fax:586-393-1518
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5140122300000X
MI2901017341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5387647Medicaid