Provider Demographics
NPI:1235379330
Name:S. JOSEPH PAUSA, DMD PC
Entity Type:Organization
Organization Name:S. JOSEPH PAUSA, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-319-9930
Mailing Address - Street 1:4895 WINDWARD PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3850
Mailing Address - Country:US
Mailing Address - Phone:678-319-9930
Mailing Address - Fax:678-319-9927
Practice Address - Street 1:4895 WINDWARD PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3850
Practice Address - Country:US
Practice Address - Phone:678-319-9930
Practice Address - Fax:678-319-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty