Individual
DOUGLAS D. PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
501 S MAIN AVE, AZTEC, NM 87410-2247
(505) 334-6116
Mailing address
501 S MAIN AVE, AZTEC, NM 87410-2247
(505) 334-6116
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD1903
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679507859
DENTAL OFFICE
NM
Enumeration date
04/16/2009
Last updated
04/16/2009
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