Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 26450 | TX |
NPI | 1003109109 |
---|---|
Provider Name | Dr. Jared Lawrence Parkinson |
First Address | Katy, TX 77494-2689 |
Second Address | La Grange, TX 78945-1926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2011 |
Last Update Date | 17/12/2014 |