Provider Demographics
NPI:1497834329
Name:PARKER, RICHARD L (DDS, MS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:PARKER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 CALIMESA BLVD
Mailing Address - Street 2:P. O. BOX 545
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-1144
Mailing Address - Country:US
Mailing Address - Phone:909-795-6019
Mailing Address - Fax:
Practice Address - Street 1:1030 CALIMESA BLVD
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1144
Practice Address - Country:US
Practice Address - Phone:909-795-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice