MEDICARE: TYFFANI TYNNEIL PALMER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	27199	TX
2	1223P0221X	Pediatric Dentistry	27199	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27199	OTHER	TX	TEXAS DENTAL LICENSE

General Provider Information

NPI Number	:	1518245331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYFFANI TYNNEIL PALMER DDS

Provider Business Mailing Address
First Line	:	1515 PAPPAS ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-1705
Country	:	US
Telephone Number	:	956-795-8100
Fax Number	:	956-718-6294

Provider Business Practice Location Address
First Line	:	7451 N BEACH ST STE 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-5160
Country	:	US
Telephone Number	:	817-847-7001
Fax Number	:	817-847-7009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	10/19/2021

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