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General NPI Number Information
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NPI Number | 1437206745
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Entity Type | Organization
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Legal Business Name | PALM & PANEK DDS PC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 158 MARCELL DR NE SUITE B
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City | ROCKFORD
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State | MI
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Zip | 49341-1362
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Country | US
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Telephone | 616-866-4200
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Fax | 616-866-0320
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Provider Business Mailing Address
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Address Line | 158 MARCELL DR NE SUITE B
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City | ROCKFORD
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State | MI
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Zip | 49341-1390
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Country | US
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Telephone | 616-866-4200
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Fax | 616-866-0320
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | SAMANTHA JO HANES
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Credential |
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Telephone | 616-361-7327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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