Healthcare Provider Details

I. General information

NPI: 1740385574
Provider Name (Legal Business Name): GARY A PARKER DDS APDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 AUSTIN ST
BOGALUSA LA
70427-3818
US

IV. Provider business mailing address

320 AUSTIN ST
BOGALUSA LA
70427-3818
US

V. Phone/Fax

Practice location:
  • Phone: 985-735-7653
  • Fax: 985-735-7688
Mailing address:
  • Phone: 985-735-7653
  • Fax: 985-735-7688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3321
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3321
License Number StateLA

VIII. Authorized Official

Name: DR. GARY A PARKER
Title or Position: DENTIST PRESIDENT
Credential: DDS
Phone: 985-735-7653