Provider Demographics
NPI:1871158329
Name:PALMER, MATTHEW ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
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 1:1597 WOODLAND PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5696
Mailing Address - Country:US
Mailing Address - Phone:801-544-1940
Mailing Address - Fax:801-896-0645
Practice Address - Street 1:1597 WOODLAND PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5696
Practice Address - Country:US
Practice Address - Phone:801-544-1940
Practice Address - Fax:801-896-0645
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0262491223G0001X
NMTD-00-112390200000X
UT131500751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program