Provider Demographics
NPI:1942385315
Name:STPAUL, JOANNE (DDS)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:STPAUL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:LOURDES
Other - Last Name:VERRIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1569 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:718-251-7167
Mailing Address - Fax:
Practice Address - Street 1:1569 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:718-251-7167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
W6L111Medicare PIN