Provider Demographics
NPI:1104020304
Name:BOOTH, PAUL LANDIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LANDIS
Last Name:BOOTH
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 1:100 INDEPENDENCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-790-8300
Mailing Address - Fax:508-790-9428
Practice Address - Street 1:100 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1898
Practice Address - Country:US
Practice Address - Phone:508-790-8300
Practice Address - Fax:508-790-9428
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice