Provider Demographics
NPI:1366597551
Name:SCOTT V. PALMER D.D.S., P.A.
Entity type:Organization
Organization Name:SCOTT V. PALMER D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-524-8661
Mailing Address - Street 1:1425 W GRAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-1270
Mailing Address - Country:US
Mailing Address - Phone:316-524-8661
Mailing Address - Fax:316-524-0331
Practice Address - Street 1:1425 W GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-1270
Practice Address - Country:US
Practice Address - Phone:316-524-8661
Practice Address - Fax:316-524-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS68931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty