Provider Demographics
NPI:1508085119
Name:MAYER, PAUL J JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:MAYER
Suffix:JR
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:S.54 W.29772 HOLIDAY RD.
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-0001
Mailing Address - Country:US
Mailing Address - Phone:262-968-6820
Mailing Address - Fax:262-968-6820
Practice Address - Street 1:470 RUBICON ST
Practice Address - Street 2:
Practice Address - City:HUSTISFORD
Practice Address - State:WI
Practice Address - Zip Code:53034-9789
Practice Address - Country:US
Practice Address - Phone:920-349-3040
Practice Address - Fax:920-349-3040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice