Healthcare Provider Details

I. General information

NPI: 1831189794
Provider Name (Legal Business Name): ALLAN S PARKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 TRUEMPER ST BLDG 6418
JBSA LACKLAND TX
78236-5511
US

IV. Provider business mailing address

16424 REVELLO DR
HELOTES TX
78023-5159
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-1035
  • Fax:
Mailing address:
  • Phone: 850-461-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number34855
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: