Provider Demographics
NPI:1326257700
Name:LALICATA, PAUL
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:LALICATA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ROUTE 236
Mailing Address - Street 2:SUITE 215
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-6000
Mailing Address - Country:US
Mailing Address - Phone:207-451-9898
Mailing Address - Fax:207-438-0257
Practice Address - Street 1:37 ROUTE 236
Practice Address - Street 2:SUITE 215
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-6000
Practice Address - Country:US
Practice Address - Phone:207-451-9898
Practice Address - Fax:207-438-0257
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5009122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist