Healthcare Provider Details

I. General information

NPI: 1316325871
Provider Name (Legal Business Name): JOHN PARKHUR DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N BROADWAY
SANTA ANA CA
92706-3906
US

IV. Provider business mailing address

1521 N BROADWAY
SANTA ANA CA
92706-3906
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-2801
  • Fax:
Mailing address:
  • Phone: 714-972-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number61010
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN PARKHUR
Title or Position: DMD
Credential:
Phone: 714-972-2801