Provider Demographics
NPI:1326123183
Name:GAUTHIER, PAUL J SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:GAUTHIER
Suffix:SR
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 1:397 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:NY
Mailing Address - Zip Code:12019
Mailing Address - Country:US
Mailing Address - Phone:518-399-7570
Mailing Address - Fax:518-399-1668
Practice Address - Street 1:397 STAGE RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:NY
Practice Address - Zip Code:12019
Practice Address - Country:US
Practice Address - Phone:518-399-7570
Practice Address - Fax:518-399-1668
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0455001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist