MEDICARE: AMY C PARKER, D.D.S.,M.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1164674776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY C PARKER, D.D.S.,M.S

Provider Business Mailing Address
First Line	:	16800 W 12 MILE RD STE 101
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-6335
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16800 W 12 MILE RD STE 101
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-6335
Country	:	US
Telephone Number	:	248-423-9800
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MELANIE JOHNSON
Credential	:
Telephone Number	:	248-423-9800

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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Directions to “AMY C PARKER, D.D.S.,M.S ” Practice Location

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