MEDICARE: BILL DEAN PARKER D.D.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	1223P0300X	Periodontics	DD1125	NM

General Provider Information

NPI Number	:	1205026796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILL DEAN PARKER D.D.S.

Provider Business Mailing Address
First Line	:	2100 CALLE DE LA VUELTA E101
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4819
Country	:	US
Telephone Number	:	505-988-8822
Fax Number	:	505-988-8824

Provider Business Practice Location Address
First Line	:	318 GRANT AVE
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-1933
Country	:	US
Telephone Number	:	505-988-8822
Fax Number	:	505-988-8824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	09/30/2015

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