Provider Demographics
NPI:1184761470
Name:PALMER, JAMES CARLTON (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CARLTON
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 1:1706 HIGHWAY 3062
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-5250
Mailing Address - Country:US
Mailing Address - Phone:318-927-3056
Mailing Address - Fax:318-927-5200
Practice Address - Street 1:729 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3314
Practice Address - Country:US
Practice Address - Phone:318-927-6152
Practice Address - Fax:318-927-5200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1840971Medicaid