Provider Demographics
NPI:1649495318
Name:PAULI, RICHARD S (DDS)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:PAULI
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 1:3500 LATOUCHE ST
Mailing Address - Street 2:STE 210
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4209
Mailing Address - Country:US
Mailing Address - Phone:907-563-3046
Mailing Address - Fax:907-563-1136
Practice Address - Street 1:3500 LATOUCHE ST
Practice Address - Street 2:STE 210
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4209
Practice Address - Country:US
Practice Address - Phone:907-563-3046
Practice Address - Fax:907-563-1136
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice