Provider Demographics
NPI:1629335419
Name:FIEDLER, PAUL W (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:FIEDLER
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 1:7447 EGAN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2254
Mailing Address - Country:US
Mailing Address - Phone:952-440-6178
Mailing Address - Fax:
Practice Address - Street 1:7447 EGAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2254
Practice Address - Country:US
Practice Address - Phone:952-440-6178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13089122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist