Provider Demographics
NPI:1588853212
Name:NIELSEN, PAUL HOWARD (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HOWARD
Last Name:NIELSEN
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 1:20591 HONEY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95467-8388
Mailing Address - Country:US
Mailing Address - Phone:707-987-3712
Mailing Address - Fax:
Practice Address - Street 1:20591 HONEY HILL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CA
Practice Address - Zip Code:95467-8388
Practice Address - Country:US
Practice Address - Phone:707-987-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist