Provider Demographics
NPI:1275695561
Name:PARKS, STUART K (DMD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:K
Last Name:PARKS
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 1:511 SW 10TH AVENUE
Mailing Address - Street 2:#1305
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205
Mailing Address - Country:US
Mailing Address - Phone:503-224-9130
Mailing Address - Fax:503-224-4549
Practice Address - Street 1:511 SW 10TH AVENUE
Practice Address - Street 2:#1305
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205
Practice Address - Country:US
Practice Address - Phone:503-224-9130
Practice Address - Fax:503-224-4549
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice