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General NPI Number Information
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NPI Number | 1427085265
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Entity Type | Individual
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Provider Name | CHARLES DOUGLAS PALMER JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 608 GRAPEVINE HWY
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City | HURST
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State | TX
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Zip | 76054-2775
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Country | US
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Telephone | 817-656-2202
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Fax | 817-656-1904
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Provider Business Mailing Address
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Address Line | 5001 GLENSHIRE DR
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City | FLOWER MOUND
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State | TX
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Zip | 75028-3172
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Country | US
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Telephone | 817-854-0705
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19327
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License Number State | TX
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