Provider Demographics
NPI:1437233517
Name:PAULEN, BRENDA G (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:G
Last Name:PAULEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 VERNON RIDGE CLOSE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4236
Mailing Address - Country:US
Mailing Address - Phone:770-481-0666
Mailing Address - Fax:770-481-0061
Practice Address - Street 1:5180 ROSWELL RD NE
Practice Address - Street 2:SOUTH BLDG - STE 101
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2293
Practice Address - Country:US
Practice Address - Phone:404-257-0091
Practice Address - Fax:404-843-0264
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0102351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN010235OtherDENTAL LICENSE NUMBER