Provider Demographics
NPI:1861418063
Name:PALETTA, STACI CHANTELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:CHANTELLE
Last Name:PALETTA
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 1:302 BROADWAY UNIT 6
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1439
Mailing Address - Country:US
Mailing Address - Phone:508-880-5891
Mailing Address - Fax:401-295-0008
Practice Address - Street 1:302 BROADWAY UNIT 6
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1439
Practice Address - Country:US
Practice Address - Phone:508-880-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN028941223X0400X
MADN18558761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics