Provider Demographics
NPI:1285757658
Name:PALMQUIST, COLLIN C (DDS)
Entity type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:C
Last Name:PALMQUIST
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 1:2702 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9138
Mailing Address - Country:US
Mailing Address - Phone:605-886-8096
Mailing Address - Fax:605-886-1979
Practice Address - Street 1:2702 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9138
Practice Address - Country:US
Practice Address - Phone:605-886-8096
Practice Address - Fax:605-886-1979
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD0609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7809990Medicaid