Provider Demographics
NPI:1235132226
Name:PAUL, EDWARD DAVID (DDS, MS FAGD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DAVID
Last Name:PAUL
Suffix:
Gender:M
Credentials:DDS, MS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 EAST AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5710
Mailing Address - Country:US
Mailing Address - Phone:203-838-3938
Mailing Address - Fax:203-866-5491
Practice Address - Street 1:161 EAST AVE STE 202
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-838-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77491223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7749OtherLICENSE NUMBER