Provider Demographics
NPI:1174195457
Name:PAULSON, ALEXANDAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDAR
Middle Name:
Last Name:PAULSON
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 1:135 HAY BARN RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8469
Mailing Address - Country:US
Mailing Address - Phone:701-426-0784
Mailing Address - Fax:
Practice Address - Street 1:1135 S CAMINO DEL RIO UNIT 210
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6831
Practice Address - Country:US
Practice Address - Phone:970-816-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD5637122300000X
CO00205087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist