Provider Demographics
NPI:1225440316
Name:PAUL, JOHN DAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAS
Last Name:PAUL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 GASTON AVE
Mailing Address - Street 2:#102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1400
Mailing Address - Country:US
Mailing Address - Phone:214-370-8383
Mailing Address - Fax:
Practice Address - Street 1:4201 GASTON AVE
Practice Address - Street 2:#102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1400
Practice Address - Country:US
Practice Address - Phone:214-370-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305391223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33907004Medicaid