Provider Demographics
NPI:1003109109
Name:PARKINSON, JARED LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:LAWRENCE
Last Name:PARKINSON
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 1:27106 HARVEST POINTE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2689
Mailing Address - Country:US
Mailing Address - Phone:443-449-9565
Mailing Address - Fax:
Practice Address - Street 1:7777 WESTGREEN BLVD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-0190
Practice Address - Country:US
Practice Address - Phone:713-462-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080462703Medicaid