Provider Demographics
NPI:1275752719
Name:PALMISCNO, RANDALL LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LEE
Last Name:PALMISCNO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CROSSROADS RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-2417
Mailing Address - Country:US
Mailing Address - Phone:724-887-3060
Mailing Address - Fax:724-887-3945
Practice Address - Street 1:111 CROSSROADS RD
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-2417
Practice Address - Country:US
Practice Address - Phone:724-887-3060
Practice Address - Fax:724-887-3945
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA029547L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist