Healthcare Provider Details

I. General information

NPI: 1316277676
Provider Name (Legal Business Name): DAVID WESLEY PARKER II M.D., D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2010
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E KINDERTON WAY
BERMUDA RUN NC
27006-7303
US

IV. Provider business mailing address

900 OLD WINSTON RD SUITE 204
KERNERSVILLE NC
27284-9964
US

V. Phone/Fax

Practice location:
  • Phone: 336-998-3300
  • Fax: 336-998-3333
Mailing address:
  • Phone: 336-992-2123
  • Fax: 336-992-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2014-02166
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: