Provider Demographics
NPI:1710955547
Name:VOLLMER, PAUL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:VOLLMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9950 VALLEY CREEK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-5803
Mailing Address - Country:US
Mailing Address - Phone:651-578-7000
Mailing Address - Fax:651-578-0157
Practice Address - Street 1:1420 LAKE ST S STE 200
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2713
Practice Address - Country:US
Practice Address - Phone:651-578-7000
Practice Address - Fax:651-464-8013
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND111261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1900010487OtherRAIROAD MEDICARE
MNU67284Medicare UPIN
MN1900010487OtherRAIROAD MEDICARE