MEDICARE: PALM & PANEK DDS PC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1649361999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM & PANEK DDS PC

Provider Business Mailing Address
First Line	:	4349 SAWKAW DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1768
Country	:	US
Telephone Number	:	616-361-7327
Fax Number	:

Provider Business Practice Location Address
First Line	:	4349 SAWKAW DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1768
Country	:	US
Telephone Number	:	616-361-7327
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	SAMANTHA JO HANES
Credential	:
Telephone Number	:	616-361-7327

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	11/02/2021

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