Provider Demographics
NPI:1851302186
Name:SHOBERG, PAUL S (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:SHOBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8736 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:LARSEN
Mailing Address - State:WI
Mailing Address - Zip Code:54947-9705
Mailing Address - Country:US
Mailing Address - Phone:920-733-4555
Mailing Address - Fax:920-733-6734
Practice Address - Street 1:230 N MORRISON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5459
Practice Address - Country:US
Practice Address - Phone:920-733-4555
Practice Address - Fax:920-733-6734
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist