Timothy Scott Paulson Jr., DMD
Individual provider Active NPI Dentist · Williams, AZ
NPI 1790139749 · NPPES record last updated Dec 10, 2021
Key facts
- NPI
- 1790139749
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 122300000 (AZ)
- Practice address
- 300 S 6TH St
Williams, AZ 86046-0110 - Phone
- (928) 635-4441
- NPI assigned
- Apr 15, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211216001179 | AZ | Practitioner - Dentist | 5294014296 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122300000 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Country Healthcare, Inc. | Current |
Accepting new patients | |
| North Country Healthcare, Inc. | Current |
Accepting new patients | |
| North Country Healthcare, Inc. | Current | Accepting new patients | |
| North Country Healthcare, Inc. | Current | Accepting new patients |
Locations
2920 N 4th St
Flagstaff, AZ 86004
Phone (928) 213-6100
300 S 6th St
Williams, AZ 86046
Phone (928) 635-4441
620 Lee St
Winslow, AZ 86047
Phone (928) 288-8700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 122300000 | AZ | Yes |
Addresses
Primary practice location
300 S 6TH St
Williams, AZ 86046-0110
Mailing address
PO Box 3630
Flagstaff, AZ 86003-3630
Phone (928) 522-9879
Other practice location 1
15229 W Elko Dr
Surprise, AZ 85374-4469
Phone (602) 919-5829
Other providers in Williams, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.