Provider Demographics
NPI:1063710705
Name:PARKER, JEFFREY MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:PARKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 FORBES AVE.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217
Mailing Address - Country:US
Mailing Address - Phone:412-422-5959
Mailing Address - Fax:412-422-5960
Practice Address - Street 1:6301 FORBES AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217
Practice Address - Country:US
Practice Address - Phone:412-422-5959
Practice Address - Fax:412-422-5960
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0383331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice