Provider Demographics
NPI:1184641821
Name:PAUL K SHICK DMD PC
Entity Type:Organization
Organization Name:PAUL K SHICK DMD PC
Other - Org Name:SOMERVILLE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-776-5900
Mailing Address - Street 1:56 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144
Mailing Address - Country:US
Mailing Address - Phone:617-776-5900
Mailing Address - Fax:617-776-0132
Practice Address - Street 1:56 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-776-5900
Practice Address - Fax:617-776-0132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty