Healthcare Provider Details

I. General information

NPI: 1215025630
Provider Name (Legal Business Name): PATRICK ANTHONY PALMA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 COMMERCIAL ST
MINGO JUNCTION OH
43938-1164
US

IV. Provider business mailing address

620 COMMERCIAL ST
MINGO JUNCTION OH
43938-1164
US

V. Phone/Fax

Practice location:
  • Phone: 740-535-0600
  • Fax:
Mailing address:
  • Phone: 740-535-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18889
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: