Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 5013 | ME |
NPI | 1346567062 |
---|---|
Provider Name | Robert D Palermo |
First Address | Kennebunk, ME 04043-7157 |
Second Address | Kennebunk, ME 04043-7157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 21/04/2010 |