Provider Demographics
NPI:1336531078
Name:JACLYN PALOLA, DMD LLC
Entity Type:Organization
Organization Name:JACLYN PALOLA, DMD LLC
Other - Org Name:PALOLA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PALOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-678-3000
Mailing Address - Street 1:94-1221 KA UKA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-6202
Mailing Address - Country:US
Mailing Address - Phone:808-678-3000
Mailing Address - Fax:808-678-0555
Practice Address - Street 1:94-1221 KA UKA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-6202
Practice Address - Country:US
Practice Address - Phone:808-678-3000
Practice Address - Fax:808-678-0555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACLYN PALOLA, DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-03
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI25131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty