Provider Demographics
NPI:1679980254
Name:PAULTRE-MICHAEL, ERICA (DDS)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PAULTRE-MICHAEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 LIVINGSTON RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4958
Mailing Address - Country:US
Mailing Address - Phone:301-265-1650
Mailing Address - Fax:301-248-6509
Practice Address - Street 1:9400 LIVINGSTON RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4958
Practice Address - Country:US
Practice Address - Phone:301-265-1650
Practice Address - Fax:301-248-6509
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice