Provider Demographics
NPI:1205026796
Name:PARKER, BILL DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:DEAN
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 1:2100 CALLE DE LA VUELTA E101
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4819
Mailing Address - Country:US
Mailing Address - Phone:505-988-8822
Mailing Address - Fax:505-988-8824
Practice Address - Street 1:318 GRANT AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1933
Practice Address - Country:US
Practice Address - Phone:505-988-8822
Practice Address - Fax:505-988-8824
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD11251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics