MEDICARE: DR. RANDALL LEE PALMISCNO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	029547L	PA

General Provider Information

NPI Number	:	1275752719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL LEE PALMISCNO DMD

Provider Business Mailing Address
First Line	:	111 CROSSROADS RD
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-2417
Country	:	US
Telephone Number	:	724-887-3060
Fax Number	:	724-887-3945

Provider Business Practice Location Address
First Line	:	111 CROSSROADS RD
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-2417
Country	:	US
Telephone Number	:	724-887-3060
Fax Number	:	724-887-3945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	03/22/2016

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