Healthcare Provider Details

I. General information

NPI: 1992302491
Provider Name (Legal Business Name): KRISTINA PALMER DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S. PENNSYLVANIA AVE 200
LANSING MI
48910-4795
US

IV. Provider business mailing address

3333 S. PENNSYLVANIA AVE 200
LANSING MI
48910-4795
US

V. Phone/Fax

Practice location:
  • Phone: 517-393-4900
  • Fax: 517-580-5133
Mailing address:
  • Phone: 517-393-4900
  • Fax: 517-580-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTINA LYNN PALMER
Title or Position: DDS
Credential:
Phone: 517-393-4900