Provider Demographics
NPI:1174262521
Name:PARKER, CHANTE MARSHAUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHANTE
Middle Name:MARSHAUN
Last Name:PARKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 S WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2412
Mailing Address - Country:US
Mailing Address - Phone:312-846-6752
Mailing Address - Fax:
Practice Address - Street 1:1680 E WEST CONNECTOR STE 112
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1241
Practice Address - Country:US
Practice Address - Phone:770-742-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00000000000000122300000X
IL019.033797122300000X
390200000X
GADN122750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program