Provider Demographics
NPI:1366842981
Name:PALMER, DALLIN (DMD)
Entity Type:Individual
Prefix:
First Name:DALLIN
Middle Name:
Last Name:PALMER
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 1:1843 E 160 S
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5587
Mailing Address - Country:US
Mailing Address - Phone:801-634-1996
Mailing Address - Fax:801-634-1996
Practice Address - Street 1:425 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-3410
Practice Address - Country:US
Practice Address - Phone:801-491-8191
Practice Address - Fax:801-491-8191
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30182122300000X
UT9461687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist