Healthcare Provider Details

I. General information

NPI: 1538182159
Provider Name (Legal Business Name): BRYON LEE PALMER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 12TH ST
BELLE PLAINE IA
52208-1709
US

IV. Provider business mailing address

804 12TH ST
BELLE PLAINE IA
52208-1709
US

V. Phone/Fax

Practice location:
  • Phone: 319-444-3343
  • Fax: 319-444-2607
Mailing address:
  • Phone: 319-444-3343
  • Fax: 319-444-2607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number07974
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: