Provider Demographics
NPI:1780711457
Name:VANHORN, PAULA (DMD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:VANHORN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 7TH ST
Mailing Address - Street 2:STE F
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-982-5673
Mailing Address - Fax:909-920-3643
Practice Address - Street 1:250 E 7TH ST
Practice Address - Street 2:STE F
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-982-5673
Practice Address - Fax:909-920-3643
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist