Provider Demographics
NPI:1972681153
Name:PALMER, JOHN A (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:PALMER
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MAIN ST
Mailing Address - Street 2:STE #930
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2726
Mailing Address - Country:US
Mailing Address - Phone:304-232-6666
Mailing Address - Fax:304-232-6666
Practice Address - Street 1:1025 MAIN ST
Practice Address - Street 2:STE #930
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2726
Practice Address - Country:US
Practice Address - Phone:304-232-6666
Practice Address - Fax:304-232-6666
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27391223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics