Provider Demographics
NPI:1609291533
Name:PARKER-GRAY PEDIATRIC DENTAL CARE, PC
Entity Type:Organization
Organization Name:PARKER-GRAY PEDIATRIC DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-651-9592
Mailing Address - Street 1:224 N FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2433
Mailing Address - Country:US
Mailing Address - Phone:703-519-7275
Mailing Address - Fax:703-519-7276
Practice Address - Street 1:224 N FAYETTE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2433
Practice Address - Country:US
Practice Address - Phone:703-519-7275
Practice Address - Fax:703-519-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-01
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014139431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty