Healthcare Provider Details

I. General information

NPI: 1619097268
Provider Name (Legal Business Name): LEE ANN PARKS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEE ANN PETROPULOS WHELAN DMD

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 TOLL GATE RD
WARWICK RI
02886-4443
US

IV. Provider business mailing address

77 TOLL GATE RD
WARWICK RI
02886-4443
US

V. Phone/Fax

Practice location:
  • Phone: 401-648-4989
  • Fax: 401-574-2051
Mailing address:
  • Phone: 401-648-4989
  • Fax: 401-574-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDEN03699
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0160002071
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN18815
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: