Provider Demographics
NPI:1033158589
Name:PALMORE, RANDALL GENE (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:GENE
Last Name:PALMORE
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-2802
Mailing Address - Country:US
Mailing Address - Phone:205-681-0459
Mailing Address - Fax:205-681-0461
Practice Address - Street 1:6960 HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-2802
Practice Address - Country:US
Practice Address - Phone:205-681-0459
Practice Address - Fax:205-681-0461
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist