Healthcare Provider Details

I. General information

NPI: 1205761376
Provider Name (Legal Business Name): TINA S PARKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 E NORTH AVE
BELTON MO
64012-2130
US

IV. Provider business mailing address

12610 ROBINSON ST APT 14206
OVERLAND PARK KS
66213-1467
US

V. Phone/Fax

Practice location:
  • Phone: 816-322-3506
  • Fax:
Mailing address:
  • Phone: 913-219-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026026777
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: