Provider Demographics
NPI:1992834840
Name:PAUL, TAHIR R (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAHIR
Middle Name:R
Last Name:PAUL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:625 W CITRACADO PKWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6428
Mailing Address - Country:US
Mailing Address - Phone:760-745-7070
Mailing Address - Fax:760-745-7077
Practice Address - Street 1:625 W CITRACADO PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6428
Practice Address - Country:US
Practice Address - Phone:760-745-7070
Practice Address - Fax:760-745-7077
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD52449Medicaid