Individual
CHARLES DUDLEY PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5004 BRAMBLETON AVE, ROANOKE, VA 24018-4642
(540) 774-1019
Mailing address
6635 MOUNT CHESTNUT RD, ROANOKE, VA 24018-8111
(540) 989-9305
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401008066
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SOCIAL SECURITY NUMBER
VA
Enumeration date
01/11/2007
Last updated
05/21/2020
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