Provider Demographics
NPI:1487765525
Name:TITUS, PAUL TERRY (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:TERRY
Last Name:TITUS
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 1:3701 PHEASANT LANE
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760
Mailing Address - Country:US
Mailing Address - Phone:607-785-5950
Mailing Address - Fax:
Practice Address - Street 1:901 FRONT STREET
Practice Address - Street 2:BROOME COMMUNITY COLLEGE-DENTAL HYGEINE SCHOOL
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902
Practice Address - Country:US
Practice Address - Phone:607-778-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist