Healthcare Provider Details

I. General information

NPI: 1043431265
Provider Name (Legal Business Name): B.J. PALMA, D.M.D., INC.
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

3143 WEST ST
WEIRTON WV
26062-4636
US

IV. Provider business mailing address

3143 WEST ST
WEIRTON WV
26062-4636
US

V. Phone/Fax

Practice location:
  • Phone: 304-748-5040
  • Fax: 304-748-5042
Mailing address:
  • Phone: 304-748-5040
  • Fax: 304-748-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2674
License Number StateWV

VIII. Authorized Official

Name: MICHAEL M. PALMA
Title or Position: ORTHODONTIST
Credential: D.M.D.
Phone: 304-748-5040