Provider Demographics
NPI:1801217542
Name:PAUL ATHANASIUS DDS, INC.
Entity Type:Organization
Organization Name:PAUL ATHANASIUS DDS, INC.
Other - Org Name:GENUINE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ATHANASIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-282-9131
Mailing Address - Street 1:1122 E LINCOLN AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1907
Mailing Address - Country:US
Mailing Address - Phone:714-282-9131
Mailing Address - Fax:714-282-9134
Practice Address - Street 1:1122 E LINCOLN AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1907
Practice Address - Country:US
Practice Address - Phone:714-282-9131
Practice Address - Fax:714-282-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59641305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service