Provider Demographics
NPI:1922378694
Name:BACALL, PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:BACALL
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 1:4809 AVENUE N
Mailing Address - Street 2:SUITE #233
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3711
Mailing Address - Country:US
Mailing Address - Phone:718-338-3202
Mailing Address - Fax:718-531-9451
Practice Address - Street 1:2501 NOSTRAND AVE
Practice Address - Street 2:SUITE #1-R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4714
Practice Address - Country:US
Practice Address - Phone:718-338-3202
Practice Address - Fax:718-531-9451
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY:DDS294731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice