Provider Demographics
NPI:1184039497
Name:PAULI, MOLLY JEAN RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:JEAN RUSSELL
Last Name:PAULI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MOLLY
Other - Middle Name:JEAN
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:640 N NEW ST
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-9459
Mailing Address - Country:US
Mailing Address - Phone:989-289-5045
Mailing Address - Fax:
Practice Address - Street 1:175 E VAN RIPER RD
Practice Address - Street 2:
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-8942
Practice Address - Country:US
Practice Address - Phone:517-223-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist