MEDICARE: DR. JACQUELINE RENEE PALAISA DMD, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	13998	MD

General Provider Information

NPI Number	:	1306825484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE RENEE PALAISA DMD, MS

Provider Business Mailing Address
First Line	:	151 BISHOP MURPHY DR
Second Line	:	SUITE B
City	:	FROSTBURG
State	:	MD
Zip	:	21532-1329
Country	:	US
Telephone Number	:	301-689-9111
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 BISHOP MURPHY DR
Second Line	:	SUITE B
City	:	FROSTBURG
State	:	MD
Zip	:	21532-1329
Country	:	US
Telephone Number	:	301-689-9111
Fax Number	:

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	05/20/2008

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