MEDICARE: DR. RONALD WAYNE PARKIN D.M.D.

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	122300000X	Dentist	13737	MO

General Provider Information

NPI Number	:	1609939461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD WAYNE PARKIN D.M.D.

Provider Business Mailing Address
First Line	:	16 RIVERBLUFF DR
Second Line	:
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019-1019
Country	:	US
Telephone Number	:	636-933-0353
Fax Number	:

Provider Business Practice Location Address
First Line	:	2380 N TRUMAN BLVD
Second Line	:
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019-1037
Country	:	US
Telephone Number	:	636-937-9193
Fax Number	:	636-937-9194

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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