Healthcare Provider Details

I. General information

NPI: 1114757986
Provider Name (Legal Business Name): PARKER LEWIS ALDREDGE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOLLOMAN MDG 280 DAVID L. GOLDFEIN STREET, BLDG 20
HOLLOMAN AFB NM
88330
US

IV. Provider business mailing address

HOLLOMAN MDG 280 DAVID L. GOLDFEIN STREET, BLDG 20
HOLLOMAN AFB NM
88330
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-8088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03054300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: