Provider Demographics
NPI:1982072146
Name:PARKER, ERIC DEWAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DEWAYNE
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 1:502 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47220-1920
Mailing Address - Country:US
Mailing Address - Phone:812-358-2037
Mailing Address - Fax:
Practice Address - Street 1:502 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-1920
Practice Address - Country:US
Practice Address - Phone:812-358-2037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012289A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice