Provider Demographics
NPI:1386655330
Name:PALMER, KENNETH MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MICHAEL
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 1:340 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5100
Mailing Address - Country:US
Mailing Address - Phone:859-344-1185
Mailing Address - Fax:859-344-1210
Practice Address - Street 1:340 THOMAS MORE PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5100
Practice Address - Country:US
Practice Address - Phone:859-344-1185
Practice Address - Fax:859-344-1210
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist