Provider Demographics
NPI:1831482348
Name:DEASEY, PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:DEASEY
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 1:22 TRUCK HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2728
Mailing Address - Country:US
Mailing Address - Phone:410-647-4269
Mailing Address - Fax:
Practice Address - Street 1:22 TRUCK HOUSE RD STE 3
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2728
Practice Address - Country:US
Practice Address - Phone:410-647-4269
Practice Address - Fax:410-544-5910
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD148011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice