Provider Demographics
NPI:1407811805
Name:PARKER, JAMES MAYNARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MAYNARD
Last Name:PARKER
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 1:5500 E KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1607
Mailing Address - Country:US
Mailing Address - Phone:316-651-3633
Mailing Address - Fax:316-634-3029
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:ROBERT J. DOLE VA MEDICAL CENTER
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-651-3633
Practice Address - Fax:316-634-3029
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist