Provider Demographics
NPI:1992302491
Name:KRISTINA PALMER DDS PLLC
Entity type:Organization
Organization Name:KRISTINA PALMER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-393-4900
Mailing Address - Street 1:3333 S. PENNSYLVANIA AVE
Mailing Address - Street 2:200
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-4795
Mailing Address - Country:US
Mailing Address - Phone:517-393-4900
Mailing Address - Fax:517-580-5133
Practice Address - Street 1:3333 S. PENNSYLVANIA AVE
Practice Address - Street 2:200
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-4795
Practice Address - Country:US
Practice Address - Phone:517-393-4900
Practice Address - Fax:517-580-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901019178OtherDENTAL