Provider Demographics
NPI:1235125097
Name:PALMORE, CARROLL ATKINS JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CARROLL
Middle Name:ATKINS
Last Name:PALMORE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4002 BREEZY HILL LN
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-8510
Mailing Address - Country:US
Mailing Address - Phone:228-875-8641
Mailing Address - Fax:
Practice Address - Street 1:606 FISHER ST
Practice Address - Street 2:81MDG/SGD
Practice Address - City:KEESLER AFB
Practice Address - State:MS
Practice Address - Zip Code:39534-2513
Practice Address - Country:US
Practice Address - Phone:228-377-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2028-831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery