Provider Demographics
NPI:1114757986
Name:ALDREDGE, PARKER LEWIS (DMD)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:LEWIS
Last Name:ALDREDGE
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 1:999 PALMER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1088
Mailing Address - Country:US
Mailing Address - Phone:732-778-4329
Mailing Address - Fax:
Practice Address - Street 1:999 PALMER AVE STE 1
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1088
Practice Address - Country:US
Practice Address - Phone:732-778-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03054300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist