Provider Demographics
NPI:1912152190
Name:PARKER, RILEY D (DMD)
Entity Type:Individual
Prefix:DR
First Name:RILEY
Middle Name:D
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 1:3112 STONEWALL DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-7817
Mailing Address - Country:US
Mailing Address - Phone:170-198-9430
Mailing Address - Fax:
Practice Address - Street 1:4501 COLEMAN ST
Practice Address - Street 2:STE 107
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503
Practice Address - Country:US
Practice Address - Phone:170-120-4723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD92141223G0001X
ND20951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice