Provider Demographics
NPI:1568894798
Name:PALMER SMILE DESIGN, PLLC
Entity Type:Organization
Organization Name:PALMER SMILE DESIGN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKILA
Authorized Official - Middle Name:JAGADISH
Authorized Official - Last Name:ANGADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-770-3441
Mailing Address - Street 1:3800 WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5028
Mailing Address - Country:US
Mailing Address - Phone:610-923-0100
Mailing Address - Fax:610-923-0115
Practice Address - Street 1:3800 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5028
Practice Address - Country:US
Practice Address - Phone:610-923-0100
Practice Address - Fax:610-923-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0372561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty