Provider Demographics
NPI:1508828997
Name:PARKS, WESLEY N (DDS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:N
Last Name:PARKS
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 1:4210 PIONEER WOODS DR
Mailing Address - Street 2:STE D
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7557
Mailing Address - Country:US
Mailing Address - Phone:402-484-6042
Mailing Address - Fax:
Practice Address - Street 1:4210 PIONEER WOODS DR
Practice Address - Street 2:STE D
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7557
Practice Address - Country:US
Practice Address - Phone:402-202-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist