Provider Demographics
NPI:1174610455
Name:YOON, PAUL C (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:YOON
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 1:110 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2708
Mailing Address - Country:US
Mailing Address - Phone:719-336-9023
Mailing Address - Fax:719-336-9064
Practice Address - Street 1:8160 S HOUGHTON RD STE 130
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9720
Practice Address - Country:US
Practice Address - Phone:520-663-4789
Practice Address - Fax:520-664-9930
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5441122300000X
AZD0110541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH67131328Medicaid