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General NPI Number Information
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NPI Number | 1114757986
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Entity Type | Individual
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Provider Name | PARKER LEWIS ALDREDGE DMD
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Gender | Male
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | HOLLOMAN MDG 280 DAVID L. GOLDFEIN STREET, BLDG 20
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City | HOLLOMAN AFB
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State | NM
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Zip | 88330
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Country | US
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Telephone | 575-572-8088
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Fax |
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Provider Business Mailing Address
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Address Line | HOLLOMAN MDG 280 DAVID L. GOLDFEIN STREET, BLDG 20
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City | HOLLOMAN AFB
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State | NM
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Zip | 88330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI03054300
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License Number State | NJ
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