Provider Demographics
NPI:1871675199
Name:PALLOTTA, JOHN R (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:PALLOTTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:19 MUZZEY ST
Mailing Address - Street 2:STE 302
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421
Mailing Address - Country:US
Mailing Address - Phone:781-861-9597
Mailing Address - Fax:781-861-3536
Practice Address - Street 1:19 MUZZEY ST
Practice Address - Street 2:STE 302
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421
Practice Address - Country:US
Practice Address - Phone:781-861-9597
Practice Address - Fax:781-861-3536
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice