Provider Demographics
NPI:1275873440
Name:PARKER DENTAL CLINIC, LLC
Entity Type:Organization
Organization Name:PARKER DENTAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:1701-989-4302
Mailing Address - Street 1:3112 STONEWALL DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-7817
Mailing Address - Country:US
Mailing Address - Phone:170-198-9430
Mailing Address - Fax:
Practice Address - Street 1:4501 COLEMAN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503
Practice Address - Country:US
Practice Address - Phone:170-120-4723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2095261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental