Provider Demographics
NPI:1568835304
Name:PAULIS, MARIE ROSE (RDH, MSDH)
Entity Type:Individual
Prefix:PROF
First Name:MARIE
Middle Name:ROSE
Last Name:PAULIS
Suffix:
Gender:F
Credentials:RDH, MSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1918
Mailing Address - Country:US
Mailing Address - Phone:203-931-6028
Mailing Address - Fax:203-931-6083
Practice Address - Street 1:419 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1918
Practice Address - Country:US
Practice Address - Phone:203-931-6028
Practice Address - Fax:203-931-6083
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005339124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist