Provider Demographics
NPI:1568617843
Name:DABNEY, PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:DABNEY
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 1:236 PRATO PL
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2170
Mailing Address - Country:US
Mailing Address - Phone:512-948-1020
Mailing Address - Fax:
Practice Address - Street 1:2726 E BUSINESS 190 STE 112
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2526
Practice Address - Country:US
Practice Address - Phone:254-987-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-30
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14486122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX999999999Medicaid