Provider Demographics
NPI:1285842229
Name:PALUSAK, JEFFREY MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:PALUSAK
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 1:155 DEAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-8496
Mailing Address - Country:US
Mailing Address - Phone:330-482-3627
Mailing Address - Fax:330-482-3627
Practice Address - Street 1:155 DEAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8496
Practice Address - Country:US
Practice Address - Phone:330-482-3627
Practice Address - Fax:330-482-3627
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-04111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice