Provider Demographics
NPI:1992920532
Name:PARKER, MICHAEL C (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:PARKER
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 1:8630 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-4907
Mailing Address - Country:US
Mailing Address - Phone:850-476-4815
Mailing Address - Fax:850-476-4831
Practice Address - Street 1:8630 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-4907
Practice Address - Country:US
Practice Address - Phone:850-476-4815
Practice Address - Fax:850-476-4831
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL69431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice