Provider Demographics
NPI:1073618146
Name:PARKER, KENDALL PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:PAUL
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 1:5121 N CLAIBORNE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-3605
Mailing Address - Country:US
Mailing Address - Phone:504-949-4547
Mailing Address - Fax:504-949-4611
Practice Address - Street 1:5121 N CLAIBORNE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-3605
Practice Address - Country:US
Practice Address - Phone:504-949-4547
Practice Address - Fax:504-949-4611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1845744Medicaid