Provider Demographics
NPI:1952546624
Name:PARKER, DAVID EARLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARLE
Last Name:PARKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2819
Mailing Address - Country:US
Mailing Address - Phone:631-724-0455
Mailing Address - Fax:631-724-0637
Practice Address - Street 1:319 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2819
Practice Address - Country:US
Practice Address - Phone:631-724-0455
Practice Address - Fax:631-724-0637
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0290801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice