Provider Demographics
NPI:1548328222
Name:MENTON, PAUL EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWARD
Last Name:MENTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:EDWARD
Other - Last Name:MENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:847 W MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-2506
Mailing Address - Country:US
Mailing Address - Phone:817-265-3159
Mailing Address - Fax:817-261-1968
Practice Address - Street 1:847 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2506
Practice Address - Country:US
Practice Address - Phone:817-265-3159
Practice Address - Fax:817-261-1968
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT14800Medicare UPIN
TX00L629Medicare UPIN