Provider Demographics
NPI:1720376478
Name:PALMER, MISTY MI'CHELE (RDH)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:MI'CHELE
Last Name:PALMER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 NE 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6990
Mailing Address - Country:US
Mailing Address - Phone:503-929-7084
Mailing Address - Fax:
Practice Address - Street 1:931 NE 73RD AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6990
Practice Address - Country:US
Practice Address - Phone:503-929-7084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5348124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist