Provider Demographics
NPI:1184153090
Name:DEMILLE, PARKER B (DMD)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:B
Last Name:DEMILLE
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 1:386 N REDWOOD RD STE 106
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2795
Mailing Address - Country:US
Mailing Address - Phone:801-397-5262
Mailing Address - Fax:
Practice Address - Street 1:386 N REDWOOD RD STE 106
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2795
Practice Address - Country:US
Practice Address - Phone:801-397-5262
Practice Address - Fax:801-397-5262
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10395704-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice