Provider Demographics
NPI:1063491462
Name:PARKER, LAVAN R III (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAVAN
Middle Name:R
Last Name:PARKER
Suffix:III
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 1:6501 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216
Mailing Address - Country:US
Mailing Address - Phone:210-341-7264
Mailing Address - Fax:210-341-2022
Practice Address - Street 1:6501 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216
Practice Address - Country:US
Practice Address - Phone:210-341-7264
Practice Address - Fax:210-341-2022
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151926601Medicaid
P00147516OtherRAILROAD MEDICARE
731009960006OtherTRICARE
TX151926608Medicaid
TX151926605Medicaid
TX151926607Medicaid
838355OtherUNITED CONCORDIA
TX151926606Medicaid
TX151926602Medicaid
80W704OtherBCBS
TX151926603Medicaid
80W704Medicare ID - Type Unspecified
TX151926602Medicaid