William Edward Paul, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12007373A Issued in IN

Practice address

926 East Lasalle Avenue
South Bend, IN 46617-2887

Phone

(574) 233-7700

Fax

(574) 233-8264

NPI assigned

Jun 6, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 17, 2023 through Apr 17, 2027

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Ajit V Pai MD

  • Interventional Pain Medicine Physician
  • Mishawaka, IN
  • NPI 1376578310
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1346289857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 EAST LASALLE AVENUE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172887",
            "telephone_number": "574-233-7700",
            "fax_number": "574-233-8264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "926 EAST LASALLE AVENUE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172887",
            "telephone_number": "574-233-7700",
            "fax_number": "574-233-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAUL",
        "first_name": "WILLIAM",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12007373A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100222380A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dale Alan Patterson, M.D.
• Richard D Patterson, DC
• Shelby Patterson, FNP-C
• Paul B. Glass DDS PC
• Paul Michael McLeod DDS, Inc.
• Yaquiris Paulino, RBT
• Matthew Pazderka
• Jessica Peachey, LMHC
• Michelle Lynn Pearson, M.D.
• Richard B Pearson

• Oral and Maxillofacial Surgery (Dentist) in South Bend, IN
• Providers in South Bend, IN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.