Provider Demographics
NPI:1730280934
Name:PALMER, DEBRA SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:SUE
Last Name:PALMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 TAYOR AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4642
Mailing Address - Country:US
Mailing Address - Phone:262-554-9055
Mailing Address - Fax:262-554-9053
Practice Address - Street 1:4425 TAYOR AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4642
Practice Address - Country:US
Practice Address - Phone:262-554-9055
Practice Address - Fax:262-554-9053
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3816WI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33497800Medicaid