Provider Demographics
NPI:1316966385
Name:PAUL A. PALO, DMD, PA
Entity type:Organization
Organization Name:PAUL A. PALO, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PALO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:863-294-7605
Mailing Address - Street 1:151 AVENUE F NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4132
Mailing Address - Country:US
Mailing Address - Phone:863-294-7605
Mailing Address - Fax:863-291-8440
Practice Address - Street 1:151 AVENUE F NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4132
Practice Address - Country:US
Practice Address - Phone:863-294-7605
Practice Address - Fax:863-291-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00123791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty