MEDICARE: DR. MAURA ELIZABETH PARKER DDS

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	1223G0001X	General Practice Dentistry	019027569	IL

General Provider Information

NPI Number	:	1700304748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURA ELIZABETH PARKER DDS

Provider Business Mailing Address
First Line	:	900 N LAKE SHORE DR APT 2202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-1576
Country	:	US
Telephone Number	:	312-823-8308
Fax Number	:

Provider Business Practice Location Address
First Line	:	6044 N AVONDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3114
Country	:	US
Telephone Number	:	773-763-1600
Fax Number	:

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

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	03/17/2018

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