Provider Demographics
NPI:1639284292
Name:PALMBERG, DALE GENE (DDS)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:GENE
Last Name:PALMBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 D HILL AVENUE
Mailing Address - Street 2:PO BOX 448
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360
Mailing Address - Country:US
Mailing Address - Phone:712-336-4895
Mailing Address - Fax:712-336-3336
Practice Address - Street 1:1510 D HILL AVENUE
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360
Practice Address - Country:US
Practice Address - Phone:712-336-4895
Practice Address - Fax:712-336-3336
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA63351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15139OtherBCBS OF IOWA
IA0151399Medicare ID - Type Unspecified