Provider Demographics
NPI:1467281451
Name:MARY PARKS DMD PLLC
Entity type:Organization
Organization Name:MARY PARKS DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY FRANCIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-507-0967
Mailing Address - Street 1:216 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-2340
Mailing Address - Country:US
Mailing Address - Phone:208-507-0867
Mailing Address - Fax:
Practice Address - Street 1:1260 SE BISHOP BLVD
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5451
Practice Address - Country:US
Practice Address - Phone:208-507-0967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental