Healthcare Provider Details

I. General information

NPI: 1821053885
Provider Name (Legal Business Name): DAVID EDWARD PALO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STATE STREET SUITE B.102
ERIE PA
16507
US

IV. Provider business mailing address

100 STATE STREET SUITE B.102
ERIE PA
16507
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-3871
  • Fax: 814-454-6294
Mailing address:
  • Phone: 814-454-3871
  • Fax: 814-454-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDA1857
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS037203
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: