Provider Demographics
NPI:1689084311
Name:PARKS CHILDREN'S DENTISTRY
Entity Type:Organization
Organization Name:PARKS CHILDREN'S DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-469-4386
Mailing Address - Street 1:9068 E 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2772
Mailing Address - Country:US
Mailing Address - Phone:402-469-4386
Mailing Address - Fax:
Practice Address - Street 1:4601 W 109TH ST
Practice Address - Street 2:SUITE 217
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1318
Practice Address - Country:US
Practice Address - Phone:402-469-4386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS610781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty