Provider Demographics
NPI:1962585547
Name:PALMIERI, ROBERTO (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:PALMIERI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 MARION DR
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:NC
Mailing Address - Zip Code:28682-9782
Mailing Address - Country:US
Mailing Address - Phone:704-995-3510
Mailing Address - Fax:
Practice Address - Street 1:311 WILLIAMSON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5966
Practice Address - Country:US
Practice Address - Phone:704-662-6020
Practice Address - Fax:704-662-6880
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902N4Medicaid
BP5979779OtherDEA