MEDICARE: DR. BARRETT J PARKER D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	20123	CA

General Provider Information

NPI Number	:	1235256017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRETT J PARKER D.D.S., M.S.

Provider Business Mailing Address
First Line	:	1622 DAYTON AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4012
Country	:	US
Telephone Number	:	510-522-0942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 SANTA CLARA AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2515
Country	:	US
Telephone Number	:	510-522-4462
Fax Number	:	510-522-4955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2007
Last Update Date	:	10/06/2008

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