Provider Demographics
NPI:1770596348
Name:PARKER, RICHARD WARREN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WARREN
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 1:3100 'O' STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-475-5149
Mailing Address - Fax:402-475-5248
Practice Address - Street 1:3100 'O' STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-475-5149
Practice Address - Fax:402-475-5248
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE39041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055086700Medicaid