Provider Demographics
NPI:1790070738
Name:PARKS, STEPHEN (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:PARKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-3257
Mailing Address - Country:US
Mailing Address - Phone:864-288-4515
Mailing Address - Fax:864-288-4992
Practice Address - Street 1:100 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-3257
Practice Address - Country:US
Practice Address - Phone:864-288-4515
Practice Address - Fax:501-676-5147
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice