Provider Demographics
NPI:1730261074
Name:PARKS, RALPH DEVON JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:DEVON
Last Name:PARKS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8626 DORCHESTER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7328
Mailing Address - Country:US
Mailing Address - Phone:843-225-7645
Mailing Address - Fax:843-225-7385
Practice Address - Street 1:8626 DORCHESTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7328
Practice Address - Country:US
Practice Address - Phone:843-225-7645
Practice Address - Fax:843-225-7385
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC19581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice