Provider Demographics
NPI:1568520336
Name:PARKER, D MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:D
Middle Name:MICHAEL
Last Name:PARKER
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 1:3615 OLD FOREST RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2952
Mailing Address - Country:US
Mailing Address - Phone:434-385-7718
Mailing Address - Fax:434-385-9691
Practice Address - Street 1:3615 OLD FOREST RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2952
Practice Address - Country:US
Practice Address - Phone:434-385-7718
Practice Address - Fax:434-385-9691
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010044671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice