Provider Demographics
NPI:1265542963
Name:DONALD C PARADISE DDS PS
Entity type:Organization
Organization Name:DONALD C PARADISE DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PARADISE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-582-1570
Mailing Address - Street 1:9618 59TH AVE SW
Mailing Address - Street 2:LAKE WOOD DENTAL BUILDING
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98498
Mailing Address - Country:US
Mailing Address - Phone:253-582-1570
Mailing Address - Fax:253-582-2323
Practice Address - Street 1:9618 59TH AVE SW
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498
Practice Address - Country:US
Practice Address - Phone:253-582-1570
Practice Address - Fax:253-582-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty