Provider Demographics
NPI:1104973734
Name:SVOBODA, PAUL J (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:SVOBODA
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3747
Mailing Address - Country:US
Mailing Address - Phone:920-922-7700
Mailing Address - Fax:920-922-1131
Practice Address - Street 1:525 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3747
Practice Address - Country:US
Practice Address - Phone:920-922-7700
Practice Address - Fax:920-922-1131
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2302-0151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics