Healthcare Provider Details

I. General information

NPI: 1336361484
Provider Name (Legal Business Name): DAVID S PALMER, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LONG CREEK DR
SOUTH PORTLAND ME
04106-2440
US

IV. Provider business mailing address

25 LONG CREEK DR
SOUTH PORTLAND ME
04106-2440
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-7767
  • Fax: 207-775-7702
Mailing address:
  • Phone: 207-775-7767
  • Fax: 207-775-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2741
License Number StateME

VIII. Authorized Official

Name: DR. DAVID S PALMER
Title or Position: PRESIDENT
Credential: DMD
Phone: 207-775-7767