Provider Demographics
NPI:1437249422
Name:PALMER, NIDA LUANGJAMEKORN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIDA
Middle Name:LUANGJAMEKORN
Last Name:PALMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6410
Mailing Address - Country:US
Mailing Address - Phone:636-441-6110
Mailing Address - Fax:636-447-5764
Practice Address - Street 1:4125 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6410
Practice Address - Country:US
Practice Address - Phone:636-441-6110
Practice Address - Fax:636-447-5764
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS604311223G0001X
MO2008011520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice