Provider Demographics
NPI:1770616633
Name:GIDDINGS, PAUL W (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:GIDDINGS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 GREYSTONE PL
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-9135
Mailing Address - Country:US
Mailing Address - Phone:864-878-2428
Mailing Address - Fax:864-878-3080
Practice Address - Street 1:108 MASSINGILL RD
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671
Practice Address - Country:US
Practice Address - Phone:864-878-2428
Practice Address - Fax:864-878-3080
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23591223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9767Medicaid