Provider Demographics
NPI:1649294018
Name:ROE, PAUL Y (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:Y
Last Name:ROE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 8TH ST. N.E.
Mailing Address - Street 2:SUITE #103
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4589
Mailing Address - Country:US
Mailing Address - Phone:253-939-3440
Mailing Address - Fax:253-939-2818
Practice Address - Street 1:1320 8TH ST. N.E.
Practice Address - Street 2:SUITE #103
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4589
Practice Address - Country:US
Practice Address - Phone:253-939-3440
Practice Address - Fax:253-939-2818
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000092721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5039789Medicaid