MEDICARE: DR. CHARLES ORVILLE PARKER III 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	1223D0001X	Public Health Dentistry	DS0000003337	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457428708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ORVILLE PARKER III D.D.S.

Provider Business Mailing Address
First Line	:	130 TUCKER LN
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2947
Country	:	US
Telephone Number	:	423-282-6564
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 PRINCETON RD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2062
Country	:	US
Telephone Number	:	423-975-2200
Fax Number	:

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	09/16/2013

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