Provider Demographics
NPI:1326003427
Name:STEPHEN M PALMER DDS PC
Entity Type:Organization
Organization Name:STEPHEN M PALMER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-333-2345
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:EAGAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85925
Mailing Address - Country:US
Mailing Address - Phone:928-333-2345
Mailing Address - Fax:928-333-2483
Practice Address - Street 1:74 N MAIN ST
Practice Address - Street 2:STE 9
Practice Address - City:EAGAR
Practice Address - State:AZ
Practice Address - Zip Code:85925
Practice Address - Country:US
Practice Address - Phone:928-333-2345
Practice Address - Fax:928-333-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty