Provider Demographics
NPI:1174066336
Name:JOSEPH O. PARAISO, DMD, INC
Entity type:Organization
Organization Name:JOSEPH O. PARAISO, DMD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:OROSA
Authorized Official - Last Name:PARAISO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-917-1077
Mailing Address - Street 1:646 SAN ANTONIO RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1304
Mailing Address - Country:US
Mailing Address - Phone:650-917-1077
Mailing Address - Fax:
Practice Address - Street 1:646 SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1304
Practice Address - Country:US
Practice Address - Phone:650-917-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427134238OtherNPI TYPE 1