Provider Demographics
NPI:1881618072
Name:PALMER, MICHAEL D (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
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 1:312 TRIBBLE GAP RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2440
Mailing Address - Country:US
Mailing Address - Phone:770-887-1399
Mailing Address - Fax:770-889-5601
Practice Address - Street 1:312 TRIBBLE GAP RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2440
Practice Address - Country:US
Practice Address - Phone:770-887-1399
Practice Address - Fax:770-889-5601
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist