Provider Demographics
NPI:1417012683
Name:PAUL S. MACE D.D.S.,M.S.D.,P.C.
Entity Type:Organization
Organization Name:PAUL S. MACE D.D.S.,M.S.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-839-4994
Mailing Address - Street 1:4585 WASHINGTON ST
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5858
Mailing Address - Country:US
Mailing Address - Phone:314-839-4994
Mailing Address - Fax:314-839-4613
Practice Address - Street 1:4585 WASHINGTON ST
Practice Address - Street 2:SUITE A-5
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5858
Practice Address - Country:US
Practice Address - Phone:314-839-4994
Practice Address - Fax:314-839-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO123731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty