Provider Demographics
NPI:1194585562
Name:PALACIOS, GERALDINE KATIUSKA (DA)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:KATIUSKA
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9075 SW 162ND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6442
Mailing Address - Country:US
Mailing Address - Phone:054-568-3143
Mailing Address - Fax:786-320-6281
Practice Address - Street 1:9075 SW 162ND AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-6442
Practice Address - Country:US
Practice Address - Phone:054-568-3143
Practice Address - Fax:786-320-6281
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant