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General NPI Number Information
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NPI Number | 1275072159
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Entity Type | Individual
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Provider Name | JOSEPH R DEPALO DMD
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Gender | Male
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 1708 N FEDERAL HWY
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City | LAKE WORTH
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State | FL
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Zip | 33460-6668
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Country | US
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Telephone | 561-944-6647
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Fax |
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Provider Business Mailing Address
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Address Line | 833 UNIVERSITY BLVD APT 303
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City | JUPITER
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State | FL
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Zip | 33458-3072
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Country | US
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Telephone | 508-596-3412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30025262
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30025262
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN24713
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License Number State | FL
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