Provider Demographics
NPI:1134282387
Name:STRANGE, PAULA STEWART
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:STEWART
Last Name:STRANGE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PAULA
Other - Middle Name:ADELAIDE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4500 I 55 N
Mailing Address - Street 2:SUITE 235
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5930
Mailing Address - Country:US
Mailing Address - Phone:601-987-8722
Mailing Address - Fax:601-987-8724
Practice Address - Street 1:505 SPRINGRIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5612
Practice Address - Country:US
Practice Address - Phone:601-924-2446
Practice Address - Fax:601-924-6030
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS288895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist