Provider Demographics
NPI:1467502724
Name:PASTERNACK, PAUL LARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LARRY
Last Name:PASTERNACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRITTON PLACE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-770-0033
Mailing Address - Fax:856-770-0608
Practice Address - Street 1:1 BRITTON PLACE
Practice Address - Street 2:SUITE 11
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-770-0033
Practice Address - Fax:856-770-0608
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009548001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3021904Medicaid