Provider Demographics
NPI:1710018882
Name:DR. PAULA S. CRUM, S.C.
Entity Type:Organization
Organization Name:DR. PAULA S. CRUM, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:920-347-2640
Mailing Address - Street 1:2581 DEVELOPMENT DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-4247
Mailing Address - Country:US
Mailing Address - Phone:920-347-2640
Mailing Address - Fax:920-347-2641
Practice Address - Street 1:2581 DEVELOPMENT DR
Practice Address - Street 2:SUITE 204
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-4247
Practice Address - Country:US
Practice Address - Phone:920-347-2640
Practice Address - Fax:920-347-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty