Provider Demographics
NPI:1780375485
Name:PARKS, MARY FRANCIS ANN
Entity type:Individual
Prefix:DR
First Name:MARY FRANCIS
Middle Name:ANN
Last Name:PARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY FRANCIS
Other - Middle Name:ANN
Other - Last Name:KASCHMITTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1260 SE BISHOP BLVD STE AANDB
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5451
Mailing Address - Country:US
Mailing Address - Phone:509-332-1509
Mailing Address - Fax:
Practice Address - Street 1:1260 SE BISHOP BLVD STE AANDB
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:509-332-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDE615785781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice