Provider Demographics
NPI:1376683193
Name:PARMLEE, RANDY A (DMD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:A
Last Name:PARMLEE
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 1:9225 SCHMALZ ROAD
Mailing Address - Street 2:
Mailing Address - City:ST JACOB
Mailing Address - State:IL
Mailing Address - Zip Code:62281
Mailing Address - Country:US
Mailing Address - Phone:618-667-8492
Mailing Address - Fax:
Practice Address - Street 1:104 E MAIN
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258
Practice Address - Country:US
Practice Address - Phone:618-566-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist