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General NPI Number Information
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NPI Number | 1407334535
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Entity Type | Individual
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Provider Name | GEORGE LEVY PARKER DDS
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Gender | Male
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 16475 SIERRA LAKES PKWY STE 140
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City | FONTANA
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State | CA
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Zip | 92336-1259
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Country | US
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Telephone | 909-357-0869
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Fax |
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Provider Business Mailing Address
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Address Line | 24920 MOUND ST
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City | LOMA LINDA
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State | CA
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Zip | 92350-0202
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Country | US
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Telephone | 909-900-3303
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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 | 102895
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License Number State | CA
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