Provider Demographics
NPI:1730399007
Name:PALUMBO, KRISTIE M (DMD)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:M
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-2813
Mailing Address - Country:US
Mailing Address - Phone:610-322-4075
Mailing Address - Fax:610-566-0922
Practice Address - Street 1:47 STATE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1544
Practice Address - Country:US
Practice Address - Phone:610-566-0291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030434L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice