Provider Demographics
NPI:1316092992
Name:PARKER, KIMBERLY WYCALL (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:WYCALL
Last Name:PARKER
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 1:531 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5300
Mailing Address - Country:US
Mailing Address - Phone:410-912-0288
Mailing Address - Fax:410-912-0294
Practice Address - Street 1:531 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5300
Practice Address - Country:US
Practice Address - Phone:410-912-0288
Practice Address - Fax:410-912-0294
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106171223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health