Provider Demographics
NPI:1831554526
Name:J. WESLEY PARKER II, DDS, PLLC
Entity type:Organization
Organization Name:J. WESLEY PARKER II, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-577-7775
Mailing Address - Street 1:27 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3219
Mailing Address - Country:US
Mailing Address - Phone:910-577-7775
Mailing Address - Fax:910-577-7199
Practice Address - Street 1:27 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3219
Practice Address - Country:US
Practice Address - Phone:910-577-7775
Practice Address - Fax:910-577-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty