MEDICARE: EDITH PALLENCAOE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	47404	CA

General Provider Information

NPI Number	:	1083849855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH PALLENCAOE DDS

Provider Business Mailing Address
First Line	:	502 FIRST ST
Second Line	:	STE. B
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-3742
Country	:	US
Telephone Number	:	805-239-9597
Fax Number	:	805-239-4142

Provider Business Practice Location Address
First Line	:	502 FIRST ST
Second Line	:	STE. B
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-3742
Country	:	US
Telephone Number	:	805-239-9597
Fax Number	:	805-239-4142

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	05/22/2009

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Directions to “ EDITH PALLENCAOE DDS” Practice Location

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