Provider Demographics
NPI:1558629261
Name:PALACIOS DENTAL CORP
Entity Type:Organization
Organization Name:PALACIOS DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:YSABEL
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-881-5007
Mailing Address - Street 1:695 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3812
Mailing Address - Country:US
Mailing Address - Phone:909-881-5007
Mailing Address - Fax:909-881-5000
Practice Address - Street 1:695 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3812
Practice Address - Country:US
Practice Address - Phone:909-881-5007
Practice Address - Fax:909-881-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty