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General NPI Number Information
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NPI Number | 1013651454
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Entity Type | Individual
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Provider Name | JUSTIN PALMER DMD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 944 N GILBERT RD STE 104
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City | MESA
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State | AZ
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Zip | 85203-5836
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Country | US
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Telephone | 480-834-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 13445 THUNDERHEAD ST
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City | SAN DIEGO
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State | CA
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Zip | 92129-2331
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Country | US
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Telephone | 403-700-7409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D011294
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License Number State | AZ
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