Provider Demographics
NPI:1215153721
Name:PARKER, CARL STEPHEN (DDS)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:STEPHEN
Last Name:PARKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:C.
Other - Middle Name:STEVE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:314 E HIGHLAND MALL BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3735
Mailing Address - Country:US
Mailing Address - Phone:512-452-9547
Mailing Address - Fax:512-452-7943
Practice Address - Street 1:314 E HIGHLAND MALL BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3735
Practice Address - Country:US
Practice Address - Phone:512-452-9547
Practice Address - Fax:512-452-7943
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice