Provider Demographics
NPI:1417058926
Name:ROBERT C. PAOLILLO,DDSPC
Entity Type:Organization
Organization Name:ROBERT C. PAOLILLO,DDSPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PAOLILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-279-3338
Mailing Address - Street 1:3904 BECK RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4952
Mailing Address - Country:US
Mailing Address - Phone:816-279-3338
Mailing Address - Fax:816-279-3339
Practice Address - Street 1:3904 BECK RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4952
Practice Address - Country:US
Practice Address - Phone:816-279-3338
Practice Address - Fax:816-279-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0127321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR680000Medicare ID - Type Unspecified