Healthcare Provider Details

I. General information

NPI: 1316925548
Provider Name (Legal Business Name): ANDREW W PARKS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E LANCASTER AVE
SHILLINGTON PA
19607-2614
US

IV. Provider business mailing address

221 E LANCASTER AVE
SHILLINGTON PA
19607-2614
US

V. Phone/Fax

Practice location:
  • Phone: 610-777-7560
  • Fax:
Mailing address:
  • Phone: 610-777-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS-025890-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: