Provider Demographics
NPI:1336230440
Name:SZMANDA, PAUL WILLIAM
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WILLIAM
Last Name:SZMANDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 CLOVER RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-8559
Mailing Address - Country:US
Mailing Address - Phone:715-359-8885
Mailing Address - Fax:715-842-4369
Practice Address - Street 1:3103 HUMMINGBIRD RD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-6311
Practice Address - Country:US
Practice Address - Phone:715-845-3200
Practice Address - Fax:715-842-4369
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3262WI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice