Provider Demographics
NPI:1013495613
Name:ANDREW C PALMER DENTISTRY, LLC
Entity Type:Organization
Organization Name:ANDREW C PALMER DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-412-1807
Mailing Address - Street 1:120 WALNUT CREEK PIKE
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1048
Mailing Address - Country:US
Mailing Address - Phone:740-477-2220
Mailing Address - Fax:740-477-1659
Practice Address - Street 1:120 WALNUT CREEK PIKE
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1048
Practice Address - Country:US
Practice Address - Phone:740-477-2220
Practice Address - Fax:740-477-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty