Provider Demographics
NPI:1700111580
Name:PALM DENTAL PLLC
Entity Type:Organization
Organization Name:PALM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:CHEI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-759-5861
Mailing Address - Street 1:2030 W BASELINE RD
Mailing Address - Street 2:SUITE 176
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6574
Mailing Address - Country:US
Mailing Address - Phone:602-759-5861
Mailing Address - Fax:623-742-9580
Practice Address - Street 1:2030 W BASELINE RD
Practice Address - Street 2:SUITE 176
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6574
Practice Address - Country:US
Practice Address - Phone:602-759-5861
Practice Address - Fax:623-742-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty