Active NPI
Roy E Paulson, DDS
- Pediatric Dentistry
- Casper, WY
National Provider Identifier
1104921907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 864
- Practice address
- 102 N Kenwood
Casper, WY 82601 - Phone
- (307) 266-1997
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 864 | WY | Primary |
Addresses
Primary practice location
102 N Kenwood
Casper, WY 82601
Mailing address
102 N Kenwood
Casper, WY 82601
Phone (307) 266-1997
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 112331901 | Medicaid | WY | |
| 112331900 | Medicaid | WY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 864 | WY | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roy E. Paulson Jr PC | Pediatric Dentistry | Past | Accepting new patients |
Interoperability endpoints
- roy.paulson@direct.wyomingmedicalcenter.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Casper, WY
- NPI 1750584173
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385078400000",
"number": "1104921907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 N KENWOOD",
"city": "CASPER",
"state": "WY",
"postal_code": "82601",
"telephone_number": "307-266-1997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 N KENWOOD",
"city": "CASPER",
"state": "WY",
"postal_code": "82601",
"telephone_number": "307-266-1997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAULSON",
"first_name": "ROY",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2013-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "WY",
"license": "864",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "112331901",
"state": "WY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "112331900",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Casper, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.