Provider Demographics
NPI:1912152521
Name:PARKER, KENNETH TREVOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:TREVOR
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 1:2431 W MAIN ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1217
Mailing Address - Country:US
Mailing Address - Phone:334-793-3651
Mailing Address - Fax:334-702-9677
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:SUITE 601
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1217
Practice Address - Country:US
Practice Address - Phone:334-793-3651
Practice Address - Fax:334-702-9677
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18467122300000X
AL5638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist