Provider Demographics
NPI:1740619980
Name:LINCOLN PARKER DMD A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:LINCOLN PARKER DMD A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:PARKER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:425-503-1607
Mailing Address - Street 1:777 CORPORATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2135
Mailing Address - Country:US
Mailing Address - Phone:949-429-0049
Mailing Address - Fax:425-671-0756
Practice Address - Street 1:777 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2135
Practice Address - Country:US
Practice Address - Phone:949-429-0049
Practice Address - Fax:425-671-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty