Provider Demographics
NPI:1235285396
Name:PALMER-ELBERTY, CYNTHIA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:MARIE
Last Name:PALMER-ELBERTY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BROOKLYN ROAD
Mailing Address - Street 2:POB 329
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068
Mailing Address - Country:US
Mailing Address - Phone:607-844-3477
Mailing Address - Fax:607-844-5313
Practice Address - Street 1:1 BROOKLYN ROAD
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068
Practice Address - Country:US
Practice Address - Phone:607-844-3477
Practice Address - Fax:607-844-5313
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0422251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice