Stephen M Palmer, DDS
Individual provider Active NPI Dentist · Eagar, AZ
NPI 1124227327 · NPPES record last updated Jul 17, 2007
Key facts
- NPI
- 1124227327
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2703 (AZ)
- Practice address
- 74 N Main St
Suite 9
Eagar, AZ 85925-9713 - Phone
- (928) 333-2345
- Fax
- (928) 333-2483
- NPI assigned
- Jul 17, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151201000704 | AZ | Order and Referring Only - Oral Surgery |
1052611845 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2703 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stephen M Palmer DDS PC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2703 | AZ | Yes |
Addresses
Primary practice location
74 N Main St
Suite 9
Eagar, AZ 85925-9713
Mailing address
PO Box 1090
Eagar, AZ 85925-1090
Phone (928) 333-2345
Other providers in Eagar, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.