Provider Demographics
NPI:1144349333
Name:PALETTA, DIANE M (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:PALETTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:MCCLUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1031 QUARRIER ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2317
Mailing Address - Country:US
Mailing Address - Phone:304-343-1733
Mailing Address - Fax:
Practice Address - Street 1:1031 QUARRIER ST
Practice Address - Street 2:SUITE 502
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2317
Practice Address - Country:US
Practice Address - Phone:304-343-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVD2670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0132979000Medicaid