Provider Demographics
NPI:1588750046
Name:PARSONS, GARY R (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:PARSONS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 CRESTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2802
Mailing Address - Country:US
Mailing Address - Phone:650-873-4685
Mailing Address - Fax:855-277-1776
Practice Address - Street 1:2102 CRESTMOOR DR
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2802
Practice Address - Country:US
Practice Address - Phone:650-873-4685
Practice Address - Fax:855-277-1776
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice