Provider Demographics
NPI:1578507109
Name:PARSONS, MICHAEL K (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:PARSONS
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 1:17300 N OUTER 40
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1361
Mailing Address - Country:US
Mailing Address - Phone:636-536-5158
Mailing Address - Fax:636-536-4544
Practice Address - Street 1:17300 N OUTER 40
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1361
Practice Address - Country:US
Practice Address - Phone:636-536-5158
Practice Address - Fax:636-536-4544
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0145711223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU13412Medicare UPIN