Provider Demographics
NPI:1437528577
Name:DESIREE T. PALMER, DMD, PA
Entity Type:Organization
Organization Name:DESIREE T. PALMER, DMD, PA
Other - Org Name:BULL CITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:TWITTY
Authorized Official - Last Name:PLAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-471-9106
Mailing Address - Street 1:105 NEWSOM STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DURHAM,
Mailing Address - State:NC
Mailing Address - Zip Code:27704
Mailing Address - Country:US
Mailing Address - Phone:919-471-9106
Mailing Address - Fax:919-477-0954
Practice Address - Street 1:106 W PARRISH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3369
Practice Address - Country:US
Practice Address - Phone:919-680-3531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESIREE T. PALMER, DMD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5320122300000X
NC8952122300000X
NC8281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty