Provider Demographics
NPI:1619163144
Name:PARIS, JOHN CHARLES (DMD,MSD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:PARIS
Suffix:
Gender:M
Credentials:DMD,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 W GREEN OAKS BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2796
Mailing Address - Country:US
Mailing Address - Phone:817-654-9053
Mailing Address - Fax:817-451-8769
Practice Address - Street 1:3825 W GREEN OAKS BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2796
Practice Address - Country:US
Practice Address - Phone:817-654-9053
Practice Address - Fax:817-451-8769
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics