Provider Demographics
NPI:1952370744
Name:PARKER, JENNIFER RENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RENE
Last Name:PARKER
Suffix:
Gender:F
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:PSC 7 BOX 866
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09104
Mailing Address - Country:US
Mailing Address - Phone:01149173-156-7473
Mailing Address - Fax:
Practice Address - Street 1:470 MEDICAL FLIGHT/GKAB/SGD
Practice Address - Street 2:UNIT: 8030
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09104
Practice Address - Country:US
Practice Address - Phone:01149245-199-3535
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist