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General NPI Number Information
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NPI Number | 1376855098
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Entity Type | Individual
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Provider Name | BRENT DAVID PARKER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 940 FRONTENAC DR
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City | WINONA
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State | MN
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Zip | 55987-6588
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Country | US
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Telephone | 507-494-8558
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 CLIFFVIEW AVE
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City | ONALASKA
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State | WI
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Zip | 54650-2003
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Country | US
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Telephone | 608-492-0478
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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 | 6545-015
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License Number State | WI
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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 | 64545-15
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D14811
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License Number State | MN
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