Provider Demographics
NPI:1720024649
Name:PALM DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:PALM DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PALM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-766-0558
Mailing Address - Street 1:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-1147
Mailing Address - Country:US
Mailing Address - Phone:410-766-0558
Mailing Address - Fax:410-766-1442
Practice Address - Street 1:7951 CRAIN HWY S
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4934
Practice Address - Country:US
Practice Address - Phone:410-766-2255
Practice Address - Fax:410-766-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD139411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty