1265056881 NPI number — PARADISE DENTAL SERVICES, INC.

Table of content: (NPI 1265056881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265056881 NPI number — PARADISE DENTAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARADISE DENTAL SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265056881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAIPAN
Provider Business Mailing Address State Name:
MP
Provider Business Mailing Address Postal Code:
96950-8901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
670-234-4040
Provider Business Mailing Address Fax Number:
670-488-1044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WAKINS BLDG. 125 MIDDLE RD. GUALO RAI
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAIPAN
Provider Business Practice Location Address State Name:
MP
Provider Business Practice Location Address Postal Code:
96950-8201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
670-789-8201
Provider Business Practice Location Address Fax Number:
670-488-1044
Provider Enumeration Date:
05/29/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KRUM
Authorized Official First Name:
NELSON
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MANAGING DENTIST
Authorized Official Telephone Number:
670-234-4040

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com