1669723557 NPI number — PARKER MODERN DENTISTRY AND ORTHODONTICS, LLP

Table of content: (NPI 1669723557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669723557 NPI number — PARKER MODERN DENTISTRY AND ORTHODONTICS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKER MODERN DENTISTRY AND ORTHODONTICS, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669723557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2860 MICHELLE FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92606-1008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-368-2084
Provider Business Mailing Address Fax Number:
714-368-2077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9871 S PARKER RD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80134-8815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-805-5703
Provider Business Practice Location Address Fax Number:
303-805-1570
Provider Enumeration Date:
10/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
O'NEILL
Authorized Official First Name:
BRADFORD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER DOCTOR
Authorized Official Telephone Number:
303-805-5703

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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