Provider Demographics
NPI:1760899884
Name:PAXMAN, DAVID MERRILL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MERRILL
Last Name:PAXMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E ORANGEBURG AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5365
Mailing Address - Country:US
Mailing Address - Phone:209-524-4763
Mailing Address - Fax:
Practice Address - Street 1:400 E ORANGEBURG AVE STE 4
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5365
Practice Address - Country:US
Practice Address - Phone:209-524-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist