Provider Demographics
NPI:1417932047
Name:PARKER, SANDRA LIZBETH (DDS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LIZBETH
Last Name:PARKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 S STATE COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4613
Mailing Address - Country:US
Mailing Address - Phone:714-289-0421
Mailing Address - Fax:714-289-0408
Practice Address - Street 1:807 E KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-4920
Practice Address - Country:US
Practice Address - Phone:714-289-0421
Practice Address - Fax:714-289-0408
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice