Provider Demographics
NPI:1912550799
Name:FAIZZADEH, PAULA ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ELIZABETH
Last Name:FAIZZADEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7933 WILDFLOWER SHORES DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2263
Mailing Address - Country:US
Mailing Address - Phone:631-258-2268
Mailing Address - Fax:
Practice Address - Street 1:4700 N CONGRESS AVE STE 302
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3292
Practice Address - Country:US
Practice Address - Phone:561-210-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN244251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty