Basic Information
Provider Information
NPI: 1841858636
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUNCAN
FirstName: PARKER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 501 LAPEER AVE
Address2:  
City: SAGINAW
State: MI
PostalCode: 486071203
CountryCode: US
TelephoneNumber: 9897596464
FaxNumber: 9893998233
Practice Location
Address1: 321 N WARREN
Address2:  
City: SAGINAW
State: MI
PostalCode: 48607
CountryCode: US
TelephoneNumber: 9897547771
FaxNumber: 9897648792
Other Information
ProviderEnumerationDate: 06/05/2019
LastUpdateDate: 05/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X2901600133MIY Dental ProvidersDentistGeneral Practice

No ID Information.


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