Provider Demographics
NPI:1326057530
Name:PARKER, GATES WASHBURN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GATES
Middle Name:WASHBURN
Last Name:PARKER
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:RR 2 BOX 225
Mailing Address - Street 2:
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328-9629
Mailing Address - Country:US
Mailing Address - Phone:570-828-2351
Mailing Address - Fax:570-828-6319
Practice Address - Street 1:934 MILFORD RD SR#1001
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328-9629
Practice Address - Country:US
Practice Address - Phone:570-828-2351
Practice Address - Fax:570-828-6319
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-024516-L122300000X
NJ22D101290900INACTIVE122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist