Provider Demographics
NPI:1154484814
Name:WAINESS, PAUL STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEVEN
Last Name:WAINESS
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 1:30140 HARPER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1610
Mailing Address - Country:US
Mailing Address - Phone:586-293-1515
Mailing Address - Fax:586-293-4459
Practice Address - Street 1:30140 HARPER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1610
Practice Address - Country:US
Practice Address - Phone:586-293-1515
Practice Address - Fax:586-293-4459
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI116431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice