MEDICARE: DR. ALLAN S PARKE 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	1223P0700X	Prosthodontics	34855	TX

General Provider Information

NPI Number	:	1831189794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN S PARKE DDS

Provider Business Mailing Address
First Line	:	16424 REVELLO DR
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-5159
Country	:	US
Telephone Number	:	850-461-6839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 TRUEMPER ST BLDG 6418
Second Line	:
City	:	JBSA LACKLAND
State	:	TX
Zip	:	78236-5511
Country	:	US
Telephone Number	:	210-292-1035
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	01/08/2025

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