Provider Demographics
NPI:1306250964
Name:PARRA, EILEEN (DDS)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:PARRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15313 1/2 FREEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2133
Mailing Address - Country:US
Mailing Address - Phone:424-217-9088
Mailing Address - Fax:
Practice Address - Street 1:13901 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-7001
Practice Address - Country:US
Practice Address - Phone:310-675-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist