Healthcare Provider Details

I. General information

NPI: 1861418063
Provider Name (Legal Business Name): STACI CHANTELLE PALETTA D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 BROADWAY UNIT 6
RAYNHAM MA
02767-1439
US

IV. Provider business mailing address

302 BROADWAY UNIT 6
RAYNHAM MA
02767-1439
US

V. Phone/Fax

Practice location:
  • Phone: 508-880-5891
  • Fax:
Mailing address:
  • Phone: 508-880-5891
  • Fax: 401-295-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN02894
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1855876
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: