Provider Demographics
NPI:1063526127
Name:MAUPIN, PAUL J (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:MAUPIN
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 1:114 E. 4TH
Mailing Address - Street 2:STE. #100
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201
Mailing Address - Country:US
Mailing Address - Phone:505-627-0141
Mailing Address - Fax:505-625-6713
Practice Address - Street 1:114 E. 4TH
Practice Address - Street 2:STE. #100
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:505-627-0141
Practice Address - Fax:505-625-6713
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM26151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13687735Medicaid