Provider Demographics
NPI:1346473220
Name:RICHARD E. PAUL DMD PC
Entity Type:Organization
Organization Name:RICHARD E. PAUL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-474-1260
Mailing Address - Street 1:2340 PATRICK HENRY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4216
Mailing Address - Country:US
Mailing Address - Phone:770-474-1260
Mailing Address - Fax:770-474-9395
Practice Address - Street 1:2340 PATRICK HENRY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4216
Practice Address - Country:US
Practice Address - Phone:770-474-1260
Practice Address - Fax:770-474-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA19NCBRPMedicare PIN