Healthcare Provider Details

I. General information

NPI: 1407185663
Provider Name (Legal Business Name): ROBERT R PARKER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PARK AVE
MERCED CA
95348-3421
US

IV. Provider business mailing address

140 PARK AVE
MERCED CA
95348-3421
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-3958
  • Fax: 209-722-3959
Mailing address:
  • Phone: 209-722-3958
  • Fax: 209-722-3959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number18743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: