Provider Demographics
NPI:1023114535
Name:PALACIOS, LOUIS MARIO (DDS)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:MARIO
Last Name:PALACIOS
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 1:81 GLEN OLEY DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9623
Mailing Address - Country:US
Mailing Address - Phone:610-779-4998
Mailing Address - Fax:
Practice Address - Street 1:6 HEARTHSTONE CT
Practice Address - Street 2:SUITE 302
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3065
Practice Address - Country:US
Practice Address - Phone:610-779-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025408L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice