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General NPI Number Information
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NPI Number | 1740385574
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Entity Type | Organization
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Legal Business Name | GARY A PARKER DDS APDC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 320 AUSTIN ST
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City | BOGALUSA
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State | LA
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Zip | 70427-3818
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Country | US
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Telephone | 985-735-7653
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Fax | 985-735-7688
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Provider Business Mailing Address
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Address Line | 320 AUSTIN ST
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City | BOGALUSA
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State | LA
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Zip | 70427-3818
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Country | US
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Telephone | 985-735-7653
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Fax | 985-735-7688
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | DR. GARY A PARKER
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Credential | DDS
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Telephone | 985-735-7653
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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 | 3321
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License Number State | LA
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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 | 3321
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License Number State | LA
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