Provider Demographics
NPI:1952781346
Name:PALMER, JENNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
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 1:20700 CHIPPENDALE AVE W STE 10
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-8206
Mailing Address - Country:US
Mailing Address - Phone:651-315-8229
Mailing Address - Fax:
Practice Address - Street 1:20700 CHIPPENDALE AVE W STE 10
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-8206
Practice Address - Country:US
Practice Address - Phone:651-315-8229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001109-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist