Ledjo Palo, D.M.D.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

12803 Issued in CT

Practice address

375 Willard Ave
Newington, CT 06111-2300

Phone

(860) 665-0444

NPI assigned

May 3, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dynamic Smiles Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Oxford, CT
  • NPI 1205685724
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1891221313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 WILLARD AVE",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061112300",
            "telephone_number": "860-665-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 WILLARD AVE",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061112300",
            "telephone_number": "860-665-0444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALO",
        "first_name": "LEDJO",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-03",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CT",
            "license": "12803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khulud Osman
• Nancy Ough, LPN
• Christine Oyola, LCSW
• Maria Pace
• Mitchell Kenneth Page, DSW, ACSW,LCSW,BCD
• Caitlin Palomba, PT
• Aileen Panarella, ST
• Karen Pankowski, OT
• Joanne S Papillo, RN,MN
• Paradigms LLC

• Orthodontics and Dentofacial Orthopedics Dentistry in Newington, CT
• Providers in Newington, CT by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.