1104239508 NPI number — IRMA IRENE PAULLEY D.D.S.

Table of content: BRIANA LEE PAIGE-ONGAY NP (NPI 1700946357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104239508 NPI number — IRMA IRENE PAULLEY D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAULLEY
Provider First Name:
IRMA
Provider Middle Name:
IRENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOERBER
Provider Other First Name:
IRMA
Provider Other Middle Name:
IRENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104239508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44031 PIPELINE PLAZA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-729-9464
Provider Business Mailing Address Fax Number:
703-729-1227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10,000 S. WILMOT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-524-0024
Provider Business Practice Location Address Fax Number:
520-524-7302
Provider Enumeration Date:
06/04/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  D020738 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)