Provider Demographics
NPI:1184828691
Name:PAUL A DAY DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:PAUL A DAY DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-589-8352
Mailing Address - Street 1:31441 SANTA MARGARITA PKWY STE G
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1838
Mailing Address - Country:US
Mailing Address - Phone:949-589-8352
Mailing Address - Fax:
Practice Address - Street 1:31441 SANTA MARGARITA PKWY STE G
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-1838
Practice Address - Country:US
Practice Address - Phone:949-589-8352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty