Provider Demographics
NPI:1144412180
Name:STAKER, ALLAN PARKER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:PARKER
Last Name:STAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 ALAMEDA BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1936
Mailing Address - Country:US
Mailing Address - Phone:505-933-6873
Mailing Address - Fax:505-503-6088
Practice Address - Street 1:1125 ALAMEDA BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1936
Practice Address - Country:US
Practice Address - Phone:505-933-6873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4091122300000X
NMDD42151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist