Provider Demographics
NPI:1497767099
Name:PARKS, LAURA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
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 1:700 EAST 2ND ST
Mailing Address - Street 2:
Mailing Address - City:IDA GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51445
Mailing Address - Country:US
Mailing Address - Phone:712-364-3101
Mailing Address - Fax:712-364-3102
Practice Address - Street 1:700 EAST 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445
Practice Address - Country:US
Practice Address - Phone:712-364-3101
Practice Address - Fax:712-364-3102
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0465203Medicaid