Provider Demographics
NPI:1427159953
Name:PAOLILLO, ROBERT CHARLES (DDSPC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:PAOLILLO
Suffix:
Gender:M
Credentials:DDSPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 BECK RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4952
Mailing Address - Country:US
Mailing Address - Phone:816-279-3338
Mailing Address - Fax:816-279-3339
Practice Address - Street 1:3904 BECK RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4952
Practice Address - Country:US
Practice Address - Phone:816-279-3338
Practice Address - Fax:816-279-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0127321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT73832Medicare UPIN
MOR686757Medicare ID - Type Unspecified