Provider Demographics
NPI:1548485782
Name:STAUBITZ, PAUL EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:STAUBITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7919 HAWKHURST
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-2362
Mailing Address - Country:US
Mailing Address - Phone:513-941-6273
Mailing Address - Fax:
Practice Address - Street 1:5536 MUDDY CREEK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2030
Practice Address - Country:US
Practice Address - Phone:513-481-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-4476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1639251895OtherDENTIST GENERAL PRACTICE