MEDICARE: DR. DAVID M PALLOTTA 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	1223E0200X	Endodontics	22DI02256100	NJ

General Provider Information

NPI Number	:	1578560108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID M PALLOTTA DMD

Provider Business Mailing Address
First Line	:	390 AMWELL RD
Second Line	:	STE 407
City	:	HILLSBOROUGH
State	:	NJ
Zip	:	08844-1247
Country	:	US
Telephone Number	:	908-359-0440
Fax Number	:	908-359-0442

Provider Business Practice Location Address
First Line	:	390 AMWELL RD
Second Line	:	STE 407
City	:	HILLSBOROUGH
State	:	NJ
Zip	:	08844-1247
Country	:	US
Telephone Number	:	908-359-0440
Fax Number	:	908-359-0442

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/08/2007

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