Provider Demographics
NPI:1245380542
Name:THOMAS, PALMER M (DMD)
Entity Type:Individual
Prefix:DR
First Name:PALMER
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 OWINGS ST
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-2738
Mailing Address - Country:US
Mailing Address - Phone:864-984-6888
Mailing Address - Fax:864-984-4474
Practice Address - Street 1:310 OWINGS ST
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2738
Practice Address - Country:US
Practice Address - Phone:864-984-6888
Practice Address - Fax:864-984-4474
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4036Medicaid