Provider Demographics
NPI:1811192917
Name:PALIOCA, ROSS K (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:K
Last Name:PALIOCA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EAST ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1369
Mailing Address - Country:US
Mailing Address - Phone:508-384-3760
Mailing Address - Fax:508-384-5083
Practice Address - Street 1:21 EAST ST
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1369
Practice Address - Country:US
Practice Address - Phone:508-384-3760
Practice Address - Fax:508-384-5083
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1821109570OtherNPI TYPE 2