Provider Demographics
NPI:1558564179
Name:STRECK, PAUL D JR (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:STRECK
Suffix:JR
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LA CAM RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3834
Mailing Address - Country:US
Mailing Address - Phone:805-376-9325
Mailing Address - Fax:
Practice Address - Street 1:15 LA CAM RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3834
Practice Address - Country:US
Practice Address - Phone:805-376-9325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068307001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery