Provider Demographics
NPI:1952999807
Name:MICHAEL WHARTON-PALMER
Entity Type:Organization
Organization Name:MICHAEL WHARTON-PALMER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHARTON-PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-774-3278
Mailing Address - Street 1:1702 ARKANSAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1610
Mailing Address - Country:US
Mailing Address - Phone:870-774-3278
Mailing Address - Fax:870-772-4593
Practice Address - Street 1:1702 ARKANSAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1610
Practice Address - Country:US
Practice Address - Phone:870-774-3278
Practice Address - Fax:870-772-4593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty