Provider Demographics
NPI:1659515773
Name:SMALL, PAULA (DDS)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MADISON AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:347-989-4441
Mailing Address - Fax:347-402-4447
Practice Address - Street 1:425 MADISON AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:347-989-4441
Practice Address - Fax:347-402-4447
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0434811223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics