Provider Demographics
NPI:1568707800
Name:PARKER, STEPHAN H (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:H
Last Name:PARKER
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6519 WILSON MILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143
Mailing Address - Country:US
Mailing Address - Phone:440-442-4800
Mailing Address - Fax:440-442-8060
Practice Address - Street 1:6519 WILSON MILLS ROAD
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:440-442-4800
Practice Address - Fax:440-442-8060
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300184431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics