Provider Demographics
NPI:1104239508
Name:PAULLEY, IRMA IRENE (DDS)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:IRENE
Last Name:PAULLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:IRMA
Other - Middle Name:IRENE
Other - Last Name:KOERBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:44031 PIPELINE PLAZA
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:703-729-9464
Mailing Address - Fax:703-729-1227
Practice Address - Street 1:10,000 S. WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85734
Practice Address - Country:US
Practice Address - Phone:520-524-0024
Practice Address - Fax:520-524-7302
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0207381223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health