Provider Demographics
NPI:1841688355
Name:PARSONS, TETYANA (BS, DMD, MS)
Entity type:Individual
Prefix:DR
First Name:TETYANA
Middle Name:
Last Name:PARSONS
Suffix:
Gender:F
Credentials:BS, DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6169 S JOG RD
Mailing Address - Street 2:STE A4
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467
Mailing Address - Country:US
Mailing Address - Phone:561-704-6906
Mailing Address - Fax:
Practice Address - Street 1:6169 S JOG RD
Practice Address - Street 2:STE A4
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467
Practice Address - Country:US
Practice Address - Phone:561-704-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN199691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics