Provider Demographics
NPI:1346415452
Name:PALERMO, ANDREW CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHARLES
Last Name:PALERMO
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 1:2 ROMANY WAY
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-5118
Mailing Address - Country:US
Mailing Address - Phone:631-368-2882
Mailing Address - Fax:631-368-0864
Practice Address - Street 1:2 ROMANY WAY
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-5118
Practice Address - Country:US
Practice Address - Phone:631-368-2882
Practice Address - Fax:631-368-0864
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist