Provider Demographics
NPI:1497769319
Name:PALUSO, GARY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:PALUSO
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 1:15725 POMERADO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2057
Mailing Address - Country:US
Mailing Address - Phone:858-451-3110
Mailing Address - Fax:858-451-2916
Practice Address - Street 1:15725 POMERADO RD STE 104
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2057
Practice Address - Country:US
Practice Address - Phone:858-451-3110
Practice Address - Fax:858-451-2916
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist