Healthcare Provider Details

I. General information

NPI: 1649361999
Provider Name (Legal Business Name): PALM & PANEK DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4349 SAWKAW DR NE
GRAND RAPIDS MI
49525-1768
US

IV. Provider business mailing address

4349 SAWKAW DR NE
GRAND RAPIDS MI
49525-1768
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-7327
  • Fax:
Mailing address:
  • Phone: 616-361-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA JO HANES
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 616-361-7327