Provider Demographics
NPI:1215198197
Name:READHEAD, PAUL HARVEY (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HARVEY
Last Name:READHEAD
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 1:2720 STANGE RD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3974
Mailing Address - Country:US
Mailing Address - Phone:515-268-0516
Mailing Address - Fax:515-268-9161
Practice Address - Street 1:2720 STANGE RD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3974
Practice Address - Country:US
Practice Address - Phone:515-268-0516
Practice Address - Fax:515-268-9161
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1075010Medicaid