Provider Demographics
NPI:1477623122
Name:PARKER, PATRICIA A (DMD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 NE CAMPUS WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5611
Mailing Address - Country:US
Mailing Address - Phone:503-952-2164
Mailing Address - Fax:503-526-4418
Practice Address - Street 1:2225 PACIFIC BLVD SE
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-7907
Practice Address - Country:US
Practice Address - Phone:541-928-4300
Practice Address - Fax:541-928-9958
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR136903OtherOREGON HEALTH PLAN