Healthcare Provider Details

I. General information

NPI: 1134216997
Provider Name (Legal Business Name): JANE ELIZABETH PARKER DDS MS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE PARKER RHYNE

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MATTHEWS TOWNSHIP PARKWAY SUITE 101
MATTHEWS NC
28105
US

IV. Provider business mailing address

1320 MATTHEWS TOWNSHIP PARKWAY SUITE 101
MATTHEWS NC
28105
US

V. Phone/Fax

Practice location:
  • Phone: 704-847-5657
  • Fax: 704-849-8721
Mailing address:
  • Phone: 704-847-5657
  • Fax: 704-849-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4387
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: