Provider Demographics
NPI:1265712483
Name:PALACIOS-BARRIONUEVO, FABIOLA ISABEL (DDS)
Entity type:Individual
Prefix:
First Name:FABIOLA
Middle Name:ISABEL
Last Name:PALACIOS-BARRIONUEVO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 SHILOH RIDGE RUN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6015
Mailing Address - Country:US
Mailing Address - Phone:770-842-4900
Mailing Address - Fax:
Practice Address - Street 1:3920 SHILOH RIDGE RUN
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6015
Practice Address - Country:US
Practice Address - Phone:770-842-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0143331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice