Provider Demographics
NPI:1104846435
Name:PALTAC, DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:PALTAC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 CENTER AVE
Mailing Address - Street 2:APT. 12B
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4948
Mailing Address - Country:US
Mailing Address - Phone:201-944-1251
Mailing Address - Fax:
Practice Address - Street 1:1441 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3321
Practice Address - Country:US
Practice Address - Phone:908-688-0022
Practice Address - Fax:908-851-9079
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019253001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice