Provider Demographics
NPI:1831216654
Name:PARKER, MICHAEL W (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:PARKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2053
Mailing Address - Country:US
Mailing Address - Phone:207-839-4513
Mailing Address - Fax:
Practice Address - Street 1:192 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2428
Practice Address - Country:US
Practice Address - Phone:207-773-1703
Practice Address - Fax:207-773-0268
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME23831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice