Provider Demographics
NPI:1487712014
Name:PABON, PAOLA MARIELY (DMD)
Entity type:Individual
Prefix:MS
First Name:PAOLA
Middle Name:MARIELY
Last Name:PABON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24B LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2913
Mailing Address - Country:US
Mailing Address - Phone:617-816-9462
Mailing Address - Fax:617-630-9129
Practice Address - Street 1:93 UNION STREET
Practice Address - Street 2:SUITE 308
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-964-3430
Practice Address - Fax:617-630-9129
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice