Provider Demographics
NPI:1871649822
Name:PARKS, DAVID KING (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KING
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 1:47 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056
Mailing Address - Country:US
Mailing Address - Phone:601-924-7441
Mailing Address - Fax:601-510-9550
Practice Address - Street 1:47 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056
Practice Address - Country:US
Practice Address - Phone:601-924-7441
Practice Address - Fax:601-510-9550
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3201011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice