Provider Demographics
NPI:1336329374
Name:DUMONT, PAUL DAVID (MSO, DOM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:DUMONT
Suffix:
Gender:M
Credentials:MSO, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 COORS BLVD NW STE E
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1926
Mailing Address - Country:US
Mailing Address - Phone:505-897-6560
Mailing Address - Fax:
Practice Address - Street 1:5115 COORS BLVD NW
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:505-897-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist