Provider Demographics
NPI:1144345273
Name:PARKER, GERALD G (DDS)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:G
Last Name:PARKER
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:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:CASSELTON
Mailing Address - State:ND
Mailing Address - Zip Code:58012-0520
Mailing Address - Country:US
Mailing Address - Phone:701-347-5345
Mailing Address - Fax:701-347-4876
Practice Address - Street 1:5 9TH AVE N
Practice Address - Street 2:
Practice Address - City:CASSELTON
Practice Address - State:ND
Practice Address - Zip Code:58012
Practice Address - Country:US
Practice Address - Phone:701-347-5345
Practice Address - Fax:701-347-4876
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND15691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice