Provider Demographics
NPI:1497892210
Name:PARAGON DENTAL PC
Entity Type:Organization
Organization Name:PARAGON DENTAL PC
Other - Org Name:MATTHEW CARTER DDS & FRED TAFOYA DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-331-2070
Mailing Address - Street 1:1221 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2837
Mailing Address - Country:US
Mailing Address - Phone:402-331-2070
Mailing Address - Fax:402-331-2186
Practice Address - Street 1:1221 GOLDEN GATE DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2837
Practice Address - Country:US
Practice Address - Phone:402-331-2070
Practice Address - Fax:402-331-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty