Provider Demographics
NPI:1619097268
Name:PARKS, LEE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANN
Last Name:PARKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LEE ANN
Other - Middle Name:PETROPULOS
Other - Last Name:WHELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1060 HINESBURG RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:802-878-0300
Mailing Address - Fax:802-872-0500
Practice Address - Street 1:1060 HINESBURG RD
Practice Address - Street 2:STE 101
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-878-0300
Practice Address - Fax:802-872-0500
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN188151223E0200X
VT01600020711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics