Provider Demographics
NPI:1801012356
Name:BEDERSON, PAUL DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:BEDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 SILVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2700
Mailing Address - Country:US
Mailing Address - Phone:301-899-2500
Mailing Address - Fax:301-899-2503
Practice Address - Street 1:4033 SILVER HILL RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-2700
Practice Address - Country:US
Practice Address - Phone:301-899-2500
Practice Address - Fax:301-899-2503
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD69371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice