MEDICARE: DR. MATHEW GREG 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	2901019381	MI
2	1223G0001X	General Practice Dentistry	D5326	ID

General Provider Information

NPI Number	:	1922165216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATHEW GREG PALMER DDS

Provider Business Mailing Address
First Line	:	3387 MERLIN DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7405
Country	:	US
Telephone Number	:	208-811-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3387 MERLIN DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7405
Country	:	US
Telephone Number	:	608-752-6848
Fax Number	:

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	06/11/2024

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