Provider Demographics
NPI:1700182854
Name:PARKER, GARY A (D D S)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:PARKER
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3818
Mailing Address - Country:US
Mailing Address - Phone:985-735-7653
Mailing Address - Fax:985-735-7688
Practice Address - Street 1:320 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3818
Practice Address - Country:US
Practice Address - Phone:985-735-7653
Practice Address - Fax:985-735-7688
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1833215Medicaid