Provider Demographics
NPI:1386653095
Name:PARKS, CHRISTOPHER ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:PARKS
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 1:400 CUMBERLAND WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-3321
Mailing Address - Country:US
Mailing Address - Phone:573-468-7556
Mailing Address - Fax:573-468-7530
Practice Address - Street 1:400 CUMBERLAND WAY
Practice Address - Street 2:SUITE A
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-3321
Practice Address - Country:US
Practice Address - Phone:573-468-7556
Practice Address - Fax:573-468-7530
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200301155591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics