Provider Demographics
NPI:1801819248
Name:PAUZA, WALTER VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:VICTOR
Last Name:PAUZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23100 CHERRY HILL ST STE 6
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1449
Mailing Address - Country:US
Mailing Address - Phone:313-792-9555
Mailing Address - Fax:
Practice Address - Street 1:23100 CHERRY HILL ST
Practice Address - Street 2:SUITE 6
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1493
Practice Address - Country:US
Practice Address - Phone:313-792-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010133741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice