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General NPI Number Information
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NPI Number | 1568707800
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Entity Type | Individual
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Provider Name | STEPHAN H. PARKER D.D.S., M.S.D.
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Gender | Male
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 6519 WILSON MILLS ROAD
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City | MAYFIELD VILLAGE
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State | OH
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Zip | 44143
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Country | US
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Telephone | 440-442-4800
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Fax | 440-442-8060
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Provider Business Mailing Address
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Address Line | 6519 WILSON MILLS ROAD
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City | MAYFIELD VILLAGE
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State | OH
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Zip | 44143
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Country | US
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Telephone | 440-442-4800
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Fax | 440-442-8060
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30018443
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License Number State | OH
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