Provider Demographics
NPI:1578085379
Name:PALMER, MELISSA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:S
Last Name:PALMER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 NW ALBRITTON LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4451
Mailing Address - Country:US
Mailing Address - Phone:386-290-0912
Mailing Address - Fax:
Practice Address - Street 1:171 NW ALBRITTON LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4451
Practice Address - Country:US
Practice Address - Phone:386-752-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22562122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No122300000XDental ProvidersDentist