Provider Demographics
NPI:1831316306
Name:PARKS, WILLIAM T III (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:PARKS
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:50 INDUSTRIAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-1246
Mailing Address - Country:US
Mailing Address - Phone:269-427-7937
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:5498 109TH AVENUE
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:MI
Practice Address - Zip Code:49450-9631
Practice Address - Country:US
Practice Address - Phone:269-236-5021
Practice Address - Fax:269-236-0505
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010162621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice