Provider Demographics
NPI:1184704314
Name:TAXIN, PAUL STEVEN (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEVEN
Last Name:TAXIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 CROMPOND ROAD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:845-226-1376
Mailing Address - Fax:845-226-5819
Practice Address - Street 1:2004 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4204
Practice Address - Country:US
Practice Address - Phone:845-226-1376
Practice Address - Fax:845-226-5819
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0359531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1184704314OtherNPI
NY1184704314OtherNPI
NY6555280001Medicare PIN