Individual
DR. KENNETH W PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
636 WEST MCNEESE ST, LAKE CHARLES, LA 70605
(337) 477-6124
(337) 477-6885
Mailing address
636 WEST MCNEESE ST, LAKE CHARLES, LA 70605
(337) 477-6124
(337) 477-6885
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
3873
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1838730
—
LA
01
—
807933
UNITED CONCORDIA
—
01
—
G1204
BLUE CROSS OF LA
—
Enumeration date
08/21/2006
Last updated
07/08/2007
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