Individual
PAUL FAVELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
W12802 CTY HWY A, BOWLER, WI 54416
(715) 793-4144
Mailing address
510 E GLENBROOK DR, PULASKI, WI 54162-9443
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1001069-15
WI
Other
Enumeration date
06/12/2015
Last updated
06/12/2015
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