Provider Demographics
NPI:1902921703
Name:PALMER, LAURENCE R (DDS)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:R
Last Name:PALMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5061
Mailing Address - Country:US
Mailing Address - Phone:801-479-8224
Mailing Address - Fax:
Practice Address - Street 1:1245 CAPITOL ST STE 106-S
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2842
Practice Address - Country:US
Practice Address - Phone:801-394-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1445261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice