Provider Demographics
NPI:1831296292
Name:PAUSA, SERGIO JOSEPH (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:JOSEPH
Last Name:PAUSA
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Gender:M
Credentials:DMD,MS
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Mailing Address - Street 1:4895 WINDWARD PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004
Mailing Address - Country:US
Mailing Address - Phone:678-319-9930
Mailing Address - Fax:678-319-9927
Practice Address - Street 1:4895 WINDWARD PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3850
Practice Address - Country:US
Practice Address - Phone:678-319-9930
Practice Address - Fax:678-319-9927
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA108201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU55970Medicare UPIN