Provider Demographics
NPI:1700948551
Name:GREENAWALT, PAUL B (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:GREENAWALT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3770
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3770
Mailing Address - Country:US
Mailing Address - Phone:360-698-9335
Mailing Address - Fax:360-698-9385
Practice Address - Street 1:9576 RIDGETOP BLVD NW
Practice Address - Street 2:#103
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8554
Practice Address - Country:US
Practice Address - Phone:360-698-9335
Practice Address - Fax:360-698-9385
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA80801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU71903Medicare UPIN