Provider Demographics
NPI:1326722331
Name:PALMER, HUNTER LOGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUNTER
Middle Name:LOGAN
Last Name:PALMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 JEFFERSON XING APT 301
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4948
Mailing Address - Country:US
Mailing Address - Phone:304-582-0410
Mailing Address - Fax:
Practice Address - Street 1:201 AUGUSTINE AVE
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-4431
Practice Address - Country:US
Practice Address - Phone:304-725-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice