Provider Demographics
NPI:1457434755
Name:J. DOUGLAS PAULUS D.D.S. INC.
Entity type:Organization
Organization Name:J. DOUGLAS PAULUS D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:PAULUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-833-4746
Mailing Address - Street 1:711 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-6829
Mailing Address - Country:US
Mailing Address - Phone:330-833-4746
Mailing Address - Fax:330-832-9928
Practice Address - Street 1:711 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-6829
Practice Address - Country:US
Practice Address - Phone:330-833-4746
Practice Address - Fax:330-832-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3001447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30-01447OtherOHIO STATE DENTAL LICENSE