Healthcare Provider Details

I. General information

NPI: 1184784290
Provider Name (Legal Business Name): DR. JERRY L. PARKER D.M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 CENTER POINT PKWY SUITE A
BIRMINGHAM AL
35215-6347
US

IV. Provider business mailing address

1263 CENTER POINT PKWY SUITE A
BIRMINGHAM AL
35215-6347
US

V. Phone/Fax

Practice location:
  • Phone: 205-856-0148
  • Fax: 205-856-3018
Mailing address:
  • Phone: 205-856-0148
  • Fax: 205-856-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2781
License Number StateAL

VIII. Authorized Official

Name: JERRY LEE PARKER
Title or Position: DENTIST
Credential:
Phone: 205-856-0148