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NPI 1336397439

NPI 1336397439 : CHRISTOPHER D PARKS DDS : ANNAPOLIS, MD

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General NPI Number Information
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    NPI Number           |    1336397439
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    Entity Type          |    Individual 
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    Provider Name        |    CHRISTOPHER D PARKS DDS
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    09/03/2008
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    Last Update Date     |    01/11/2023
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Provider Practice Location Address
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    Address Line         |    695 KINKAID RD 
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    City                 |    ANNAPOLIS
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    State                |    MD
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    Zip                  |    21402-1006
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    Country              |    US
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    Telephone            |    410-293-3936
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    695 KINKAID RD 
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    City                 |    ANNAPOLIS
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    State                |    MD
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    Zip                  |    21402-1006
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    Country              |    US
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    Telephone            |    410-293-3936
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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        |    122300000X
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    Taxonomy Name        |    Dentist
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    License Number       |    054402
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    License Number State |    NY
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Taxonomy #2
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    Taxonomy Code        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    054402
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    License Number State |    NY
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