Provider Demographics
NPI:1790710424
Name:PARROTT, JEREMY DERIK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DERIK
Last Name:PARROTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 HOLLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:248-875-7269
Mailing Address - Fax:
Practice Address - Street 1:1936 HOLLAND AVENUE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-987-8310
Practice Address - Fax:810-987-2692
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027072122300000X
RIDEN 03060122300000X
MI2901020215122300000X, 1223G0001X
TN9118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist