Basic Information
| Provider Information | |||||||||
| NPI: | 1831316306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 INDUSTRIAL PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490131246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694277937 | ||||||||
| FaxNumber: | 2694275180 | ||||||||
| Practice Location | |||||||||
| Address1: | 5498 109TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | PULLMAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494509631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2692365021 | ||||||||
| FaxNumber: | 2692360505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 06/23/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 2901016262 | MI | Y | Dental Providers | Dentist | General Practice |
No ID Information.