Provider Demographics
NPI:1295927416
Name:LETELLIER, PAUL ROBERT JR (DDS, MS, MSD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:LETELLIER
Suffix:JR
Gender:M
Credentials:DDS, MS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4647 SWEETWATER BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:281-340-3636
Mailing Address - Fax:281-340-3638
Practice Address - Street 1:4647 SWEETWATER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-340-3636
Practice Address - Fax:281-340-3638
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX252811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics