Provider Demographics
NPI:1134988801
Name:PALMER, CARRIE BRADSTREET (RDH)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:BRADSTREET
Last Name:PALMER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:BRADSTREET
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38850 ROAD G
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-8917
Mailing Address - Country:US
Mailing Address - Phone:970-422-2860
Mailing Address - Fax:
Practice Address - Street 1:106 W NORTH ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3119
Practice Address - Country:US
Practice Address - Phone:970-565-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002025520124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist