Healthcare Provider Details

I. General information

NPI: 1972681153
Provider Name (Legal Business Name): JOHN A. PALMER DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MAIN ST STE #930
WHEELING WV
26003-2726
US

IV. Provider business mailing address

1025 MAIN ST STE #930
WHEELING WV
26003-2726
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-6666
  • Fax: 304-232-6666
Mailing address:
  • Phone: 304-232-6666
  • Fax: 304-232-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2739
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: