MEDICARE: DR. BRYON LEE PALMER D.D.S.

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	07974	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77990078	OTHER	IA	ADA NUMBER

General Provider Information

NPI Number	:	1538182159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYON LEE PALMER D.D.S.

Provider Business Mailing Address
First Line	:	804 12TH ST
Second Line	:
City	:	BELLE PLAINE
State	:	IA
Zip	:	52208-1709
Country	:	US
Telephone Number	:	319-444-3343
Fax Number	:	319-444-2607

Provider Business Practice Location Address
First Line	:	804 12TH ST
Second Line	:
City	:	BELLE PLAINE
State	:	IA
Zip	:	52208-1709
Country	:	US
Telephone Number	:	319-444-3343
Fax Number	:	319-444-2607

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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