Provider Demographics
NPI:1316121197
Name:PAUNOVIC, BOGDAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:M
Last Name:PAUNOVIC
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 1:1 POWELTON RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2229
Mailing Address - Country:US
Mailing Address - Phone:845-562-8046
Mailing Address - Fax:845-562-8075
Practice Address - Street 1:1 POWELTON RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2229
Practice Address - Country:US
Practice Address - Phone:845-562-8046
Practice Address - Fax:845-562-8075
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist