Provider Demographics
NPI:1467476721
Name:LEDERMAN, PAUL B (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:LEDERMAN
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 1:14575 BEL RED RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3908
Mailing Address - Country:US
Mailing Address - Phone:425-746-6020
Mailing Address - Fax:425-401-5118
Practice Address - Street 1:14575 BEL RED RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3908
Practice Address - Country:US
Practice Address - Phone:425-746-6020
Practice Address - Fax:425-401-5118
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA62591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice