Healthcare Provider Details

I. General information

NPI: 1508277930
Provider Name (Legal Business Name): JUAN MARTIN PALOMO DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 CORNELL RD DENTAL SCHOOL - ORTHODONTICS
CLEVELAND OH
44106-3804
US

IV. Provider business mailing address

2124 CORNELL RD DENTAL SCHOOL - ORTHODONTICS
CLEVELAND OH
44106-3804
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-2449
  • Fax: 216-368-3204
Mailing address:
  • Phone: 216-368-2449
  • Fax: 216-368-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number71-0000149
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: