Provider Demographics
NPI:1083849855
Name:PALLENCAOE, EDITH (DDS)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:PALLENCAOE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 FIRST ST
Mailing Address - Street 2:STE. B
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-3742
Mailing Address - Country:US
Mailing Address - Phone:805-239-9597
Mailing Address - Fax:805-239-4142
Practice Address - Street 1:502 FIRST ST
Practice Address - Street 2:STE. B
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3742
Practice Address - Country:US
Practice Address - Phone:805-239-9597
Practice Address - Fax:805-239-4142
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist