Provider Demographics
NPI:1285662163
Name:WILLIAM E PAUL DDS PC
Entity Type:Organization
Organization Name:WILLIAM E PAUL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-233-7700
Mailing Address - Street 1:926 EAST LASALLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2887
Mailing Address - Country:US
Mailing Address - Phone:574-233-7700
Mailing Address - Fax:574-233-8264
Practice Address - Street 1:926 EAST LASALLE AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2887
Practice Address - Country:US
Practice Address - Phone:574-233-7700
Practice Address - Fax:574-233-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U28562Medicare UPIN
IN736780Medicare ID - Type Unspecified