Provider Demographics
NPI:1790816874
Name:CRUM, PAULA S (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:S
Last Name:CRUM
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics