Provider Demographics
NPI:1821221367
Name:VIDZIUNAS, PAUL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:VIDZIUNAS
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 1:2100 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4704
Mailing Address - Country:US
Mailing Address - Phone:410-686-4646
Mailing Address - Fax:410-686-4896
Practice Address - Street 1:2100 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-4704
Practice Address - Country:US
Practice Address - Phone:410-686-4646
Practice Address - Fax:410-686-4896
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD82501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice