Provider Demographics
NPI:1427878479
Name:JACQUELINE PALAISA DMD MS
Entity type:Organization
Organization Name:JACQUELINE PALAISA DMD MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PALAISA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:301-689-9111
Mailing Address - Street 1:151 BISHOP MURPHY DR STE B
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-1329
Mailing Address - Country:US
Mailing Address - Phone:301-689-9111
Mailing Address - Fax:
Practice Address - Street 1:151 BISHOP MURPHY DR STE B
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-1329
Practice Address - Country:US
Practice Address - Phone:301-689-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty