MEDICARE: DR. CHARLES ALLEN PARKER DDS

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	12881	TX

General Provider Information

NPI Number	:	1588683338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ALLEN PARKER DDS

Provider Business Mailing Address
First Line	:	1809 S WASHINGTON AVE
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75670-6855
Country	:	US
Telephone Number	:	903-935-6282
Fax Number	:	903-927-0097

Provider Business Practice Location Address
First Line	:	1809 S WASHINGTON AVE
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75670-6855
Country	:	US
Telephone Number	:	903-935-6282
Fax Number	:	903-927-0097

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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