Provider Demographics
NPI:1194903567
Name:COLLIN C. PALMQUIST DDS, PC
Entity type:Organization
Organization Name:COLLIN C. PALMQUIST DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-886-8096
Mailing Address - Street 1:600 4TH ST NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1898
Mailing Address - Country:US
Mailing Address - Phone:605-886-8096
Mailing Address - Fax:605-886-1979
Practice Address - Street 1:600 4TH ST NE
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1898
Practice Address - Country:US
Practice Address - Phone:605-886-8096
Practice Address - Fax:605-886-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDO6091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7809990Medicaid