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General NPI Number Information
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NPI Number | 1013233832
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Entity Type | Organization
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Legal Business Name | PHILLIP E. PARKER, D.D.S., PC
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 3669 MAIN STREET
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City | STONE RIDGE
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State | NY
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Zip | 12484-0553
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Country | US
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Telephone | 845-687-0066
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 553 3669 MAIN ST.
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City | STONE RIDGE
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State | NY
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Zip | 12484-0553
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Country | US
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Telephone | 845-687-0066
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PHILLIP E. PARKER
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Credential | D.D.S.
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Telephone | 845-687-0066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 040-171-1
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License Number State | NY
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