Provider Demographics
NPI:1750365458
Name:PALMER, CHARLES B (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
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:PO BOX 394
Mailing Address - Street 2:15587 KINGS HWY
Mailing Address - City:MONTROSS
Mailing Address - State:VA
Mailing Address - Zip Code:22520-0394
Mailing Address - Country:US
Mailing Address - Phone:804-493-8993
Mailing Address - Fax:804-493-0907
Practice Address - Street 1:15587 KINGS HWY
Practice Address - Street 2:
Practice Address - City:MONTROSS
Practice Address - State:VA
Practice Address - Zip Code:22520-0394
Practice Address - Country:US
Practice Address - Phone:804-493-8993
Practice Address - Fax:804-493-0907
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010063521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA028269OtherANTHEM PROVIDER
435766OtherUNITED CONCORDIA