Provider Demographics
NPI:1598851263
Name:PALERMO, MAURICE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:R
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 1:601 W MOANA LN STE 4
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4959
Mailing Address - Country:US
Mailing Address - Phone:775-825-8783
Mailing Address - Fax:775-825-8791
Practice Address - Street 1:601 W MOANA LN STE 4
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4959
Practice Address - Country:US
Practice Address - Phone:775-825-8783
Practice Address - Fax:775-825-8791
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV88-0175912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist