Provider Demographics
NPI:1336400472
Name:PARKER, MATTHEW REED (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:REED
Last Name:PARKER
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 1:8519 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5401
Mailing Address - Country:US
Mailing Address - Phone:801-602-3985
Mailing Address - Fax:801-386-5552
Practice Address - Street 1:8519 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5401
Practice Address - Country:US
Practice Address - Phone:801-602-3985
Practice Address - Fax:801-386-5552
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0084191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice