Provider Demographics
NPI:1265056881
Name:PARADISE DENTAL SERVICES, INC.
Entity type:Organization
Organization Name:PARADISE DENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:670-234-4040
Mailing Address - Street 1:PO BOX 10001
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-8901
Mailing Address - Country:US
Mailing Address - Phone:670-234-4040
Mailing Address - Fax:670-488-1044
Practice Address - Street 1:WAKINS BLDG. 125 MIDDLE RD. GUALO RAI
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-8201
Practice Address - Country:US
Practice Address - Phone:670-789-8201
Practice Address - Fax:670-488-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental