Provider Demographics
NPI:1740385574
Name:GARY A PARKER DDS APDC
Entity Type:Organization
Organization Name:GARY A PARKER DDS APDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-735-7653
Mailing Address - Street 1:320 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3818
Mailing Address - Country:US
Mailing Address - Phone:985-735-7653
Mailing Address - Fax:985-735-7688
Practice Address - Street 1:320 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3818
Practice Address - Country:US
Practice Address - Phone:985-735-7653
Practice Address - Fax:985-735-7688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3321122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1833215Medicaid