Terra Shivon Pauly, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

60618 Issued in KS

Practice address

4620 E Douglas Ave Ste 100
Wichita, KS 67208-3955

Phone

(316) 263-0889

NPI assigned

Aug 3, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 12, 2015 through Oct 12, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1249257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595808000000",
    "number": "1407087851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 E DOUGLAS AVE STE 100",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672083955",
            "telephone_number": "316-263-0889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 E DOUGLAS AVE STE 100",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672083955",
            "telephone_number": "316-263-0889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULY",
        "first_name": "TERRA",
        "middle_name": "SHIVON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-03",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "60618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@paulydentalgroup.com",
            "affiliation": "N",
            "endpointDescription": "office email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4620 E Douglas Ave Ste 100",
            "city": "Wichita",
            "state": "KS",
            "country_code": "US",
            "postal_code": "672083955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carol Hammon Paulson, PHD, RN, ARNP
• Pauly Dental LLC
• Ashleigh Jay Pauly, CRNA
• Emily Pauly, COTA/L
• Michelle Pauly
• Samuel Paunetto-Rivera, LMSW
• Allyson E Pavlacka
• Sara A Pavlick, LMSW
• Jessica Paxson, M.D.
• Randolph J Paxson, LMSW

• Dentist in Wichita, KS
• Providers in Wichita, KS by specialty
• Dentist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.