MEDICARE: DR. RALPH DEVON PARKS JR. D.M.D.

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	1958	SC

General Provider Information

NPI Number	:	1730261074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH DEVON PARKS JR. D.M.D.

Provider Business Mailing Address
First Line	:	8626 DORCHESTER RD
Second Line	:	SUITE 102
City	:	N CHARLESTON
State	:	SC
Zip	:	29420-7328
Country	:	US
Telephone Number	:	843-225-7645
Fax Number	:	843-225-7385

Provider Business Practice Location Address
First Line	:	8626 DORCHESTER RD
Second Line	:	SUITE 102
City	:	N CHARLESTON
State	:	SC
Zip	:	29420-7328
Country	:	US
Telephone Number	:	843-225-7645
Fax Number	:	843-225-7385

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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