Provider Demographics
NPI:1114967262
Name:ANFENSON, PAUL M (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:ANFENSON
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 1:115 S WILKE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1532
Mailing Address - Country:US
Mailing Address - Phone:847-253-0195
Mailing Address - Fax:
Practice Address - Street 1:115 S WILKE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1532
Practice Address - Country:US
Practice Address - Phone:847-253-0195
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice