Provider Demographics
NPI:1578689410
Name:PALMER, REBECCA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:PALMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:MCINTOSH-PALMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3250 PLYMOUTH RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2592
Mailing Address - Country:US
Mailing Address - Phone:734-769-2707
Mailing Address - Fax:734-769-0298
Practice Address - Street 1:3250 PLYMOUTH RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2592
Practice Address - Country:US
Practice Address - Phone:734-769-2707
Practice Address - Fax:734-769-0298
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0156191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice