Provider Demographics
NPI:1508277930
Name:PALOMO, JUAN MARTIN (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MARTIN
Last Name:PALOMO
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 CORNELL RD
Mailing Address - Street 2:DENTAL SCHOOL - ORTHODONTICS
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3804
Mailing Address - Country:US
Mailing Address - Phone:216-368-2449
Mailing Address - Fax:216-368-3204
Practice Address - Street 1:2124 CORNELL RD
Practice Address - Street 2:DENTAL SCHOOL - ORTHODONTICS
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3804
Practice Address - Country:US
Practice Address - Phone:216-368-2449
Practice Address - Fax:216-368-3204
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH71-00001491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics