| Sandra Parker Dds, Inc. | |
|
807 E Katella Ave Orange CA 92867-4920 | |
| (714) 289-0421 | |
| (714) 289-0408 |
| Full Name | Sandra Parker Dds, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 807 E Katella Ave, Orange, California |
| Authorized Official Name and Position | Sandra Parker (SHARE HOLDER) |
| Authorized Official Contact | 7142890421 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandra Parker Dds, Inc. 807 E Katella Ave Orange CA 92867-4920 Ph: (714) 289-0421 | Sandra Parker Dds, Inc. 807 E Katella Ave Orange CA 92867-4920 Ph: (714) 289-0421 |
| NPI Number | 1558680264 |
|---|---|
| Provider Enumeration Date | 05/19/2010 |
| Last Update Date | 05/19/2010 |
| Medicare PECOS PAC ID | 6800137399 |
|---|---|
| Medicare Enrollment ID | O20190410001689 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558680264 | NPI | - | NPPES |
| G93900-01 | Other | CA | MEDICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 50505 (California) | Primary |
| Provider Name | Sandra Lizbeth Parker |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1417932047 PECOS PAC ID: 7618218108 Enrollment ID: I20190410001777 |
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