Provider Demographics
NPI:1881811701
Name:PALMER, ANDREW CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHARLES
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 1:595 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1131
Mailing Address - Country:US
Mailing Address - Phone:740-477-6270
Mailing Address - Fax:
Practice Address - Street 1:600 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1226
Practice Address - Country:US
Practice Address - Phone:740-477-2220
Practice Address - Fax:740-477-1659
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0224081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2689292Medicaid