Individual
PARKER DURANT GROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10010 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1626
(260) 490-9949
Mailing address
10010 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1626
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12014105A
IN
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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