Provider Demographics
NPI:1104590652
Name:PALANO, SAMUEL PHILLIP (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PHILLIP
Last Name:PALANO
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 1:3800 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6238
Mailing Address - Country:US
Mailing Address - Phone:925-778-8080
Mailing Address - Fax:
Practice Address - Street 1:3800 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6238
Practice Address - Country:US
Practice Address - Phone:925-778-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1064211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice