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NPI Code Detail

MEDICARE: JAN DIANE PARKER SMART DDS

MEDICARE:   JAN DIANE PARKER SMART  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
11223G0001XGeneral Practice Dentistry6057CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16057OTHERCOSTATE LICENSE

General Provider Information

NPI Number : 1629150073
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAN DIANE PARKER SMART DDS
Provider Business Mailing Address
First Line : 7180 E ORCHARD RD
Second Line :
City : CENTENNIAL
State : CO
Zip : 80111-1724
Country : US
Telephone Number : 303-741-9949
Fax Number : 303-741-9969
Provider Business Practice Location Address
First Line : 7180 E ORCHARD RD
Second Line :
City : CENTENNIAL
State : CO
Zip : 80111-1724
Country : US
Telephone Number : 303-741-9949
Fax Number : 303-741-9969
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 07/08/2007

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Directions to “ JAN DIANE PARKER SMART DDS” Practice Location

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