Provider Demographics
NPI:1881854149
Name:PALMER, CHRISTOPHER ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ADAM
Last Name:PALMER
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 1:12147 NATURAL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2018
Mailing Address - Country:US
Mailing Address - Phone:314-739-3700
Mailing Address - Fax:
Practice Address - Street 1:12147 NATURAL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2018
Practice Address - Country:US
Practice Address - Phone:314-739-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070192441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice