MEDICARE: MICHAEL WHARTON-PALMER

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1952999807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL WHARTON-PALMER

Provider Business Mailing Address
First Line	:	1702 ARKANSAS BLVD
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-1610
Country	:	US
Telephone Number	:	870-774-3278
Fax Number	:	870-772-4593

Provider Business Practice Location Address
First Line	:	1702 ARKANSAS BLVD
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-1610
Country	:	US
Telephone Number	:	870-774-3278
Fax Number	:	870-772-4593

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	DEBRA A WHARTON-PALMER
Credential	:
Telephone Number	:	870-774-3278

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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Directions to “MICHAEL WHARTON-PALMER ” Practice Location

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