Provider Demographics
NPI:1548475437
Name:PARKER, HUGH DONOVAN ST JUSTIN (DMD)
Entity type:Individual
Prefix:DR
First Name:HUGH
Middle Name:DONOVAN ST JUSTIN
Last Name:PARKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17220 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1329
Mailing Address - Country:US
Mailing Address - Phone:718-297-2220
Mailing Address - Fax:718-291-4176
Practice Address - Street 1:17220 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1329
Practice Address - Country:US
Practice Address - Phone:718-297-2220
Practice Address - Fax:718-291-4176
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038067-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00936723Medicaid