Provider Demographics
NPI:1003221854
Name:CRAIG R. PARLET D.D.S.
Entity Type:Organization
Organization Name:CRAIG R. PARLET D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:HAZELTON
Authorized Official - Last Name:ISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-528-6200
Mailing Address - Street 1:1675 BRIARGATE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3452
Mailing Address - Country:US
Mailing Address - Phone:719-528-6200
Mailing Address - Fax:719-534-9713
Practice Address - Street 1:1675 BRIARGATE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3452
Practice Address - Country:US
Practice Address - Phone:719-528-6200
Practice Address - Fax:719-534-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty