MEDICARE: ROBERT C. PAOLILLO,DDSPC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	012732	MO

General Provider Information

NPI Number	:	1417058926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT C. PAOLILLO,DDSPC

Provider Business Mailing Address
First Line	:	3904 BECK RD
Second Line	:	SUITE 150
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-4952
Country	:	US
Telephone Number	:	816-279-3338
Fax Number	:	816-279-3339

Provider Business Practice Location Address
First Line	:	3904 BECK RD
Second Line	:	SUITE 150
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-4952
Country	:	US
Telephone Number	:	816-279-3338
Fax Number	:	816-279-3339

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT CHARLES PAOLILLO
Credential	:	DDS
Telephone Number	:	816-279-3338

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/22/2020

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