Provider Demographics
NPI:1134125248
Name:PAUL, RICHARD ERIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ERIC
Last Name:PAUL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2340 PATRICK HENRY PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4214
Mailing Address - Country:US
Mailing Address - Phone:770-474-1260
Mailing Address - Fax:770-474-9395
Practice Address - Street 1:2340 PATRICK HENRY PKWY
Practice Address - Street 2:STE 100
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4214
Practice Address - Country:US
Practice Address - Phone:770-474-1260
Practice Address - Fax:770-474-9395
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA112361223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA56761Medicare UPIN
GA19NCBRPMedicare UPIN