Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 23849 | TX |
NPI | 1922275247 |
---|---|
Provider Name | Dr. Brent Parker |
First Address | Houston, TX 77024-1640 |
Second Address | Houston, TX 77024-1640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 20/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
198831301 | (05) | TX |