Provider Demographics
NPI:1437206745
Name:PALM & PANEK DDS PC
Entity Type:Organization
Organization Name:PALM & PANEK DDS PC
Other - Org Name:CENTER FOR ORAL SURGERY & DENTAL IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-361-7327
Mailing Address - Street 1:158 MARCELL DR NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1390
Mailing Address - Country:US
Mailing Address - Phone:616-866-4200
Mailing Address - Fax:616-866-0320
Practice Address - Street 1:158 MARCELL DR NE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1362
Practice Address - Country:US
Practice Address - Phone:616-866-4200
Practice Address - Fax:616-866-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D16148Medicare PIN