Provider Demographics
NPI:1407142698
Name:CHRISTOPHER A. PARKS, DDS, P.C.
Entity type:Organization
Organization Name:CHRISTOPHER A. PARKS, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-468-7556
Mailing Address - Street 1:400 CUMBERLAND WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-3321
Mailing Address - Country:US
Mailing Address - Phone:573-468-7556
Mailing Address - Fax:
Practice Address - Street 1:400 CUMBERLAND WAY
Practice Address - Street 2:SUITE A
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-3321
Practice Address - Country:US
Practice Address - Phone:573-468-7556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty