Provider Demographics
NPI:1790174282
Name:PALLAY, ANNE MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:PALLAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 TRIFECTA PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-5652
Mailing Address - Country:US
Mailing Address - Phone:304-725-0508
Mailing Address - Fax:
Practice Address - Street 1:46 TRIFECTA PL
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-5652
Practice Address - Country:US
Practice Address - Phone:304-725-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice