Basic Information
| Provider Information | |||||||||
| NPI: | 1619992112 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALMER | ||||||||
| FirstName: | ZANE | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 84 NW 2ND ST | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979142412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418890052 | ||||||||
| FaxNumber: | 5418890990 | ||||||||
| Practice Location | |||||||||
| Address1: | 84 NW 2ND ST | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979142412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418890052 | ||||||||
| FaxNumber: | 5418890990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 06/18/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D8744 | OR | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | D8744 | 01 | OR | DENTAL LICENSE | OTHER |