Individual
DR. ANITA JO PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
390 RAILROAD ST STE D, BOLIVAR, TN 38008-2661
(731) 658-6112
(731) 658-6059
Mailing address
390 RAILROAD ST STE D, BOLIVAR, TN 38008-2661
(731) 658-6112
(731) 658-6059
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7263
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1764104
UNITED CONCORDIA
TN
01
—
203022415
TAX ID
TN
01
—
4108150
BCBST
TN
Enumeration date
03/16/2007
Last updated
08/25/2016
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