Provider Demographics
NPI:1457040867
Name:PARHAM, MARY CASON
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CASON
Last Name:PARHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 EL SALVADOR WAY
Mailing Address - Street 2:
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-1711
Mailing Address - Country:US
Mailing Address - Phone:850-885-7565
Mailing Address - Fax:
Practice Address - Street 1:4315 EL SALVADOR WAY
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1711
Practice Address - Country:US
Practice Address - Phone:850-885-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant