Provider Demographics
NPI:1538182159
Name:PALMER, BRYON LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYON
Middle Name:LEE
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 1:804 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:IA
Mailing Address - Zip Code:52208-1709
Mailing Address - Country:US
Mailing Address - Phone:319-444-3343
Mailing Address - Fax:319-444-2607
Practice Address - Street 1:804 12TH ST
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:IA
Practice Address - Zip Code:52208-1709
Practice Address - Country:US
Practice Address - Phone:319-444-3343
Practice Address - Fax:319-444-2607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA77990078OtherADA NUMBER