Provider Demographics
NPI:1134546716
Name:PARKER DENTAL & ORTHODONTICS
Entity type:Organization
Organization Name:PARKER DENTAL & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:228-283-5022
Mailing Address - Street 1:11628 HIGHWAY 57
Mailing Address - Street 2:PO BOX 5786
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-8231
Mailing Address - Country:US
Mailing Address - Phone:228-283-5022
Mailing Address - Fax:228-283-5017
Practice Address - Street 1:PO BOX BOX 5786
Practice Address - Street 2:
Practice Address - City:VANCLEAVE
Practice Address - State:MS
Practice Address - Zip Code:39565-5786
Practice Address - Country:US
Practice Address - Phone:228-283-5022
Practice Address - Fax:228-283-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS27441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty