Provider Demographics
NPI:1063522803
Name:PARKER, PHILLIP R (DDS MS MS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:R
Last Name:PARKER
Suffix:
Gender:M
Credentials:DDS MS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W ROBINSON
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072
Mailing Address - Country:US
Mailing Address - Phone:405-329-8853
Mailing Address - Fax:405-329-8894
Practice Address - Street 1:3700 W ROBINSON
Practice Address - Street 2:SUITE 102
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-329-8853
Practice Address - Fax:405-329-8894
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4376122300000X
OK471223P0221X
OK1181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics