Provider Demographics
NPI:1922006527
Name:PALMER, MARK LOUIS (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LOUIS
Last Name:PALMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NE EADS ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-2840
Mailing Address - Country:US
Mailing Address - Phone:541-265-7727
Mailing Address - Fax:541-574-8861
Practice Address - Street 1:101 NE EADS ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-2840
Practice Address - Country:US
Practice Address - Phone:541-265-7727
Practice Address - Fax:541-574-8861
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
OR57621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice