Organization
PEDIATRIC DENTIST, PDC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON D PARKER DDS (PRESIDENT)
(504) 669-8679
Entity
Organization
Contact information
Practice address
2201 VETERANS MEMORIAL BLVD, SUITE 306, METAIRIE, LA 70002
(504) 831-2120
(504) 831-2310
Mailing address
2201 VETERANS MEMORIAL BLVD, SUITE 306, METAIRIE, LA 70002
(504) 831-2120
(504) 831-2310
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5132
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851329
—
LA
Enumeration date
02/27/2007
Last updated
08/22/2020
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