Provider Demographics
NPI:1326855123
Name:STANWAY, PARKER LEWIS (DMD)
Entity type:Individual
Prefix:DR
First Name:PARKER
Middle Name:LEWIS
Last Name:STANWAY
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 1:35095 SERENADE
Mailing Address - Street 2:
Mailing Address - City:THOUSAND PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92276-4125
Mailing Address - Country:US
Mailing Address - Phone:760-799-7199
Mailing Address - Fax:
Practice Address - Street 1:78595 HIGHWAY 111 STE 300
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2084
Practice Address - Country:US
Practice Address - Phone:760-771-0300
Practice Address - Fax:760-771-0420
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist