Provider Demographics
NPI:1023174133
Name:PARKER, GREGORY A (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:PARKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:A
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,PA
Mailing Address - Street 1:4900 SW 2ND TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-6747
Mailing Address - Country:US
Mailing Address - Phone:352-873-9758
Mailing Address - Fax:352-732-4561
Practice Address - Street 1:2835 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0444
Practice Address - Country:US
Practice Address - Phone:352-732-3985
Practice Address - Fax:352-732-4561
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN113351223G0001X
MND100361223G0001X
WI3756-0151223G0001X
CA372721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice