Provider Demographics
NPI:1134216997
Name:PARKER, JANE ELIZABETH (DDS MS PA)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELIZABETH
Last Name:PARKER
Suffix:
Gender:F
Credentials:DDS MS PA
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:PARKER
Other - Last Name:RHYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1320 MATTHEWS TOWNSHIP PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:704-847-5657
Mailing Address - Fax:704-849-8721
Practice Address - Street 1:1320 MATTHEWS TOWNSHIP PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-847-5657
Practice Address - Fax:704-849-8721
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
U52770Medicare UPIN