Provider Demographics
NPI:1235117748
Name:MUCCI, PAUL CARMEN (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CARMEN
Last Name:MUCCI
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 1:327 LONG POINT DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-4116
Mailing Address - Country:US
Mailing Address - Phone:361-643-5238
Mailing Address - Fax:361-776-1103
Practice Address - Street 1:327 CORAL SEA RD
Practice Address - Street 2:SUITE 148
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-5055
Practice Address - Country:US
Practice Address - Phone:361-776-4581
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021629L1223G0001X
TX183891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice