=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548327695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREGORY A PARKER D.D.S.,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2835 SE 3RD CT
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-0444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-732-3985
-----------------------------------------------------
Fax | 352-732-4561
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2835 SE 3RD CT
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-0444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-732-3985
-----------------------------------------------------
Fax | 352-732-4561
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE OFFICER
-----------------------------------------------------
Name | GREGORY A PARKER
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 352-732-3985
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN11335
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------