Provider Demographics
NPI:1619730181
Name:PALLACK, CINDY HAESE (RDH)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:HAESE
Last Name:PALLACK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 SLAGROVE CT
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4666
Mailing Address - Country:US
Mailing Address - Phone:917-382-1044
Mailing Address - Fax:
Practice Address - Street 1:2668 SLAGROVE CT
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4666
Practice Address - Country:US
Practice Address - Phone:407-725-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026047-01124Q00000X
FLDH24140124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist