Provider Demographics
NPI:1982865465
Name:PALLISER, PAUL ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALLEN
Last Name:PALLISER
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 1:700 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1919
Mailing Address - Country:US
Mailing Address - Phone:847-639-3031
Mailing Address - Fax:847-639-3084
Practice Address - Street 1:700 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-1919
Practice Address - Country:US
Practice Address - Phone:847-639-3031
Practice Address - Fax:847-639-3084
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-021139-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist