Provider Demographics
NPI:1881814275
Name:PALMER, KRISTINA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LYNN
Last Name:PALMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 S PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-4795
Mailing Address - Country:US
Mailing Address - Phone:517-393-4900
Mailing Address - Fax:
Practice Address - Street 1:3333 S PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-4795
Practice Address - Country:US
Practice Address - Phone:517-393-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19178122300000X, 1223G0001X
MI29010191781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist