Healthcare Provider Details

I. General information

NPI: 1710819156
Provider Name (Legal Business Name): PARKER PDC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11183 S PARKER RD UNIT C
PARKER CO
80134-4905
US

IV. Provider business mailing address

727 E UTAH VALLEY DR
AMERICAN FORK UT
84003-3345
US

V. Phone/Fax

Practice location:
  • Phone: 303-805-3655
  • Fax:
Mailing address:
  • Phone: 303-805-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. JAXON DOWNING
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 801-305-3460