Provider Demographics
NPI:1578697504
Name:PARKER, ANTHONY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
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 1:5912 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3130
Mailing Address - Country:US
Mailing Address - Phone:773-282-1541
Mailing Address - Fax:773-282-4881
Practice Address - Street 1:5912 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3130
Practice Address - Country:US
Practice Address - Phone:773-282-1541
Practice Address - Fax:773-282-4881
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A151481223G0001X
IL0210012891223P0300X
IL0210012001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0300XDental ProvidersDentistPeriodontics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0080016184OtherBCBS MEDICAL PROVIDER #