Provider Demographics
NPI:1841414646
Name:DANIELS PARKS, GWENDOLYN ROCHIE (DDS)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:ROCHIE
Last Name:DANIELS PARKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 QUEENS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3672
Mailing Address - Country:US
Mailing Address - Phone:301-779-2744
Mailing Address - Fax:301-779-6447
Practice Address - Street 1:2201 QUEENS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3672
Practice Address - Country:US
Practice Address - Phone:301-779-2744
Practice Address - Fax:301-779-6447
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD10129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist