Provider Demographics
NPI:1417065293
Name:KODET, PAUL RUSSEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RUSSEL
Last Name:KODET
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3711
Mailing Address - Country:US
Mailing Address - Phone:530-885-6559
Mailing Address - Fax:530-885-6550
Practice Address - Street 1:185 PALM AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3711
Practice Address - Country:US
Practice Address - Phone:530-885-6559
Practice Address - Fax:530-885-6550
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist