Provider Demographics
NPI:1720157316
Name:PARKER, DARYL A (DDS)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:A
Last Name:PARKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E FLAMING GORGE WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935
Mailing Address - Country:US
Mailing Address - Phone:307-875-3924
Mailing Address - Fax:
Practice Address - Street 1:190 E FLAMING GORGE WAY
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935
Practice Address - Country:US
Practice Address - Phone:307-875-3924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice