Basic Information
| Provider Information | |||||||||
| NPI: | 1952397770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAULETTE | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | WILSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 QUARLES CT | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228018797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404320609 | ||||||||
| FaxNumber: | 5404329097 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 QUARLES CT | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228018797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404320609 | ||||||||
| FaxNumber: | 5404329097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 0401006427 | VA | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.