Provider Demographics
NPI:1922174432
Name:SERGIO, PAUL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:SERGIO
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 1:1918 EDISON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1711
Mailing Address - Country:US
Mailing Address - Phone:574-287-8900
Mailing Address - Fax:
Practice Address - Street 1:1918 EDISON RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1711
Practice Address - Country:US
Practice Address - Phone:574-287-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0085151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics