Healthcare Provider Details

I. General information

NPI: 1235156670
Provider Name (Legal Business Name): MICHAEL VICTOR PALASZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TOLL GATE RD STE A
LITITZ PA
17543-7777
US

IV. Provider business mailing address

4 TOLL GATE RD STE A
LITITZ PA
17543-7777
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-0600
  • Fax: 717-626-8813
Mailing address:
  • Phone: 717-626-0600
  • Fax: 717-626-8813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS027878L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: