MEDICARE: DALLIN CLARK PARKINSON DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	S2-205C	NV
2	390200000X	Student in an Organized Health Care Education/Training Program	RES-30525	IA
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D011305	AZ

General Provider Information

NPI Number	:	1497255699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLIN CLARK PARKINSON DMD

Provider Business Mailing Address
First Line	:	6452 E CARONDELET DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2212
Country	:	US
Telephone Number	:	520-296-3000
Fax Number	:	520-733-9000

Provider Business Practice Location Address
First Line	:	6780 S FORT APACHE RD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5405
Country	:	US
Telephone Number	:	725-234-3341
Fax Number	:

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

Provider Enumeration Date	:	02/15/2018
Last Update Date	:	10/23/2025

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