Provider Demographics
NPI:1447511738
Name:DR. PAUL'S FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:DR. PAUL'S FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FROUDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-727-3032
Mailing Address - Street 1:12650 GEORGIA HIGHWAY 144
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7339
Mailing Address - Country:US
Mailing Address - Phone:912-727-3032
Mailing Address - Fax:
Practice Address - Street 1:12650 GEORGIA HIGHWAY 144
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7339
Practice Address - Country:US
Practice Address - Phone:912-727-3032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-03
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0138571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty