Provider Demographics
NPI:1831536846
Name:PARKER, LINCOLN CHARLES (DMD)
Entity type:Individual
Prefix:MR
First Name:LINCOLN
Middle Name:CHARLES
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 1:777 CORPORATE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2138
Mailing Address - Country:US
Mailing Address - Phone:949-429-0049
Mailing Address - Fax:949-602-9274
Practice Address - Street 1:777 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2135
Practice Address - Country:US
Practice Address - Phone:949-429-0049
Practice Address - Fax:949-602-9274
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist