Individual
DR. JUSTIN RAY PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7370 S. PINE CREEK RD, MILL CREEK, OK 74856
(580) 371-3900
(589) 371-3903
Mailing address
1520 E MAIN ST, TISHOMINGO, OK 73460-2409
(580) 371-3900
(580) 371-3903
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5619
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200003990A
—
OK
Enumeration date
04/19/2007
Last updated
01/04/2012
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