Provider Demographics
NPI:1629294186
Name:MEVOLI, PAUL A (DMD PA)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:MEVOLI
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 PARK ST N
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1028
Mailing Address - Country:US
Mailing Address - Phone:727-541-5606
Mailing Address - Fax:727-545-9723
Practice Address - Street 1:5415 PARK ST N
Practice Address - Street 2:SUITE A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1028
Practice Address - Country:US
Practice Address - Phone:727-541-5606
Practice Address - Fax:727-545-9723
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
23422OtherUNITED CONCORDIA
60707OtherBLUE CROSS BLUE SHIELD