Provider Demographics
NPI:1922446426
Name:ROLLINS, PAUL (DMD, MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1204
Mailing Address - Country:US
Mailing Address - Phone:330-929-2808
Mailing Address - Fax:
Practice Address - Street 1:57 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1204
Practice Address - Country:US
Practice Address - Phone:330-929-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN99611223S0112X
OHRES.33241223S0112X
OH30.0260821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery