Provider Demographics
NPI:1245309467
Name:PARKHURST, STEVEN MICAH (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICAH
Last Name:PARKHURST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 CROSSOVER LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4905
Mailing Address - Country:US
Mailing Address - Phone:901-683-4369
Mailing Address - Fax:901-767-6222
Practice Address - Street 1:722 CROSSOVER LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4905
Practice Address - Country:US
Practice Address - Phone:901-683-4369
Practice Address - Fax:901-767-6222
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice