MEDICARE: DR. ANTHONY J. 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	1223G0001X	General Practice Dentistry	19A15148	IL
2	1223P0300X	Periodontics	021001289	IL
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	021001200	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0080016184	OTHER	IL	BCBS MEDICAL PROVIDER #

General Provider Information

NPI Number	:	1578697504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY J. PARKER D.D.S.

Provider Business Mailing Address
First Line	:	5912 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3130
Country	:	US
Telephone Number	:	773-282-1541
Fax Number	:	773-282-4881

Provider Business Practice Location Address
First Line	:	5912 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3130
Country	:	US
Telephone Number	:	773-282-1541
Fax Number	:	773-282-4881

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	05/29/2013

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Directions to “ DR. ANTHONY J. PARKER D.D.S.” Practice Location

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