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General NPI Number Information
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NPI Number | 1245447689
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Entity Type | Individual
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Provider Name | TIMOTHY PALMER DDS
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19240 QUESADA AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-3126
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Country | US
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Telephone | 941-743-7435
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Fax |
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Provider Business Mailing Address
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Address Line | 754 ANNA HOPE LN
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City | OSPREY
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State | FL
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Zip | 34229-8865
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Country | US
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Telephone |
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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 | DN-15315
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License Number State | FL
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