Provider Demographics
NPI:1285746966
Name:PALMER, DESIREE TWITTY (DMD)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:TWITTY
Last Name:PALMER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NEWSOM ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2197
Mailing Address - Country:US
Mailing Address - Phone:919-471-9106
Mailing Address - Fax:919-477-0954
Practice Address - Street 1:105 NEWSOM ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2197
Practice Address - Country:US
Practice Address - Phone:919-471-9106
Practice Address - Fax:919-477-0954
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89996583Medicaid