Provider Demographics
NPI:1700816519
Name:PALMA, JACOB E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:E
Last Name:PALMA
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 1:7011 HOLLY MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-3532
Mailing Address - Country:US
Mailing Address - Phone:210-536-1846
Mailing Address - Fax:210-536-3049
Practice Address - Street 1:2200 BERGQUIST DR STE 1
Practice Address - Street 2:ATT: CREDENTIALS ( CMC)
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-536-1846
Practice Address - Fax:210-536-3049
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice