Provider Demographics
NPI:1396973228
Name:PAULUSSEN, DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:PAULUSSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 ROUTE 46 W
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5335
Mailing Address - Country:US
Mailing Address - Phone:908-850-4200
Mailing Address - Fax:908-850-3730
Practice Address - Street 1:354 ROUTE 46 W
Practice Address - Street 2:SUITE 1A
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-5335
Practice Address - Country:US
Practice Address - Phone:908-850-4200
Practice Address - Fax:908-850-3730
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1255482048OtherTYPE 2 NPI