Provider Demographics
NPI:1558351254
Name:HONEYCUTT, PAUL E (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:HONEYCUTT
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 1:1240 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2445
Mailing Address - Country:US
Mailing Address - Phone:931-728-3501
Mailing Address - Fax:931-728-3554
Practice Address - Street 1:1240 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2445
Practice Address - Country:US
Practice Address - Phone:931-728-3501
Practice Address - Fax:931-728-3554
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
00751411OtherUNITED CONCORDIA
3127467OtherBLUE CROSS/ BLUE SHEILD
TN0016010Medicaid