Healthcare Provider Details

I. General information

NPI: 1578085379
Provider Name (Legal Business Name): MELISSA S PALMER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 NW ALBRITTON LN
LAKE CITY FL
32055-4451
US

IV. Provider business mailing address

171 NW ALBRITTON LN
LAKE CITY FL
32055-4451
US

V. Phone/Fax

Practice location:
  • Phone: 386-752-5904
  • Fax:
Mailing address:
  • Phone: 386-290-0912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22562
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN22562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: