MEDICARE: GRAYSON PALMER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	61604	CA

General Provider Information

NPI Number	:	1184971590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRAYSON PALMER DDS

Provider Business Mailing Address
First Line	:	831 HARRIS ST STE A
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95503-4501
Country	:	US
Telephone Number	:	707-499-0026
Fax Number	:	707-443-2371

Provider Business Practice Location Address
First Line	:	831 HARRIS ST STE A
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95503-4501
Country	:	US
Telephone Number	:	707-443-8367
Fax Number	:	707-443-2371

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	06/03/2026

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