Provider Demographics
NPI:1861402158
Name:PALMER, GRETCHEN M (DDS)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:M
Last Name:PALMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GRETCHEN
Other - Middle Name:M
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2000 WINTON RD SOUTH
Mailing Address - Street 2:BLDG 4 SUITE 300
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-427-2620
Mailing Address - Fax:585-292-6265
Practice Address - Street 1:2000 WINTON RD SOUTH
Practice Address - Street 2:BLDG 4 SUITE 300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-427-2620
Practice Address - Fax:585-292-6265
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0498451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice