MEDICARE: PARKER SHIFFLER DDS, MD

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	122300000X	Dentist	64079	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	11640344-9924	UT

General Provider Information

NPI Number	:	1639514896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARKER SHIFFLER DDS, MD

Provider Business Mailing Address
First Line	:	7390 S CREEK RD STE 101
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6121
Country	:	US
Telephone Number	:	503-756-5726
Fax Number	:

Provider Business Practice Location Address
First Line	:	7390 S CREEK RD STE 101
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6121
Country	:	US
Telephone Number	:	801-255-2422
Fax Number	:

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

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	04/13/2022

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