Provider Demographics
NPI:1639214935
Name:PARKER, AMY (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16800 W 12 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6335
Mailing Address - Country:US
Mailing Address - Phone:248-423-9800
Mailing Address - Fax:
Practice Address - Street 1:16800 W 12 MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2108
Practice Address - Country:US
Practice Address - Phone:248-423-9800
Practice Address - Fax:248-423-3486
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry