Provider Demographics
NPI:1447412465
Name:PARKS, LAURIE RENAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:RENAE
Last Name:PARKS
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 1:9191 KYSER WAY # 405123
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1902
Mailing Address - Country:US
Mailing Address - Phone:972-712-2700
Mailing Address - Fax:
Practice Address - Street 1:9191 KYSER WAY # 405123
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1902
Practice Address - Country:US
Practice Address - Phone:972-712-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics