Provider Demographics
NPI:1881868677
Name:UPTON, PAUL MIKE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MIKE
Last Name:UPTON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 RICE MINE RD N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2314
Mailing Address - Country:US
Mailing Address - Phone:205-752-4343
Mailing Address - Fax:
Practice Address - Street 1:815 RICE MINE RD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2314
Practice Address - Country:US
Practice Address - Phone:205-752-4343
Practice Address - Fax:205-752-4347
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics