Provider Demographics
NPI:1063584001
Name:PAULY, JAMES C (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:PAULY
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 1:1940 W GALENA BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4319
Mailing Address - Country:US
Mailing Address - Phone:630-892-8933
Mailing Address - Fax:630-892-8935
Practice Address - Street 1:1940 W GALENA BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4319
Practice Address - Country:US
Practice Address - Phone:630-892-8933
Practice Address - Fax:630-892-8935
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice