Healthcare Provider Details

I. General information

NPI: 1114120425
Provider Name (Legal Business Name): MEREDITH SLOAN PARKS DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 VILLAGE AVE STE A
YORKTOWN VA
23693-5638
US

IV. Provider business mailing address

211 VILLAGE AVE STE A
YORKTOWN VA
23693-5638
US

V. Phone/Fax

Practice location:
  • Phone: 757-874-6655
  • Fax: 757-874-6560
Mailing address:
  • Phone: 757-874-6655
  • Fax: 757-874-6560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401411268
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: