Provider Demographics
NPI:1770936171
Name:PAUL, DALLAS JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:JOSEPH
Last Name:PAUL
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 1:4200 N FALCON DR UNIT 97
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2306
Mailing Address - Country:US
Mailing Address - Phone:702-305-5836
Mailing Address - Fax:
Practice Address - Street 1:14815 W BELL RD STE 202
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7611
Practice Address - Country:US
Practice Address - Phone:632-547-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002028571223G0001X
AZD0096721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice