Individual
PHILLIP PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3669 MAIN ST, STONE RIDGE, NY 12484-5613
(845) 687-0066
Mailing address
24 TWIN PONDS DR, KINGSTON, NY 12401-6432
(845) 338-2999
Taxonomy
Speciality
Code
Description
License number
State
125K00000X
Advanced Practice Dental Therapist
Primary
040 171 1
NY
Other
Enumeration date
07/25/2014
Last updated
07/25/2014
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