Provider Demographics
NPI:1124227327
Name:PALMER, STEPHEN M (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
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:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:EAGAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85925-1090
Mailing Address - Country:US
Mailing Address - Phone:928-333-2345
Mailing Address - Fax:928-333-2483
Practice Address - Street 1:74 N MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:EAGAR
Practice Address - State:AZ
Practice Address - Zip Code:85925-9713
Practice Address - Country:US
Practice Address - Phone:928-333-2345
Practice Address - Fax:928-333-2483
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist