Provider Demographics
NPI:1396803599
Name:PAUL, DAVID H (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:PAUL
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 1:114 W COMMERCIAL ST
Mailing Address - Street 2:PO BOX 1005
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622-7614
Mailing Address - Country:US
Mailing Address - Phone:417-345-7415
Mailing Address - Fax:417-345-7415
Practice Address - Street 1:114 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622-7614
Practice Address - Country:US
Practice Address - Phone:417-345-7415
Practice Address - Fax:417-345-7415
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist