Ty Parker DMD PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TY PARKER DMD PC

Practice address

314 Fountains Pkwy Ste C
Fairview Heights, IL 62208-2165

Phone

(618) 622-1800

Fax

(618) 622-0007

NPI assigned

Jun 12, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Steve McCann

Title

Office Manager

Phone

(618) 622-1800

Specialties & licenses 1

Addresses

Other names 1

• Fountains Family Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ty Parker, DMD

  • General Practice Dentistry
  • Fairview Heights, IL
  • NPI 1417156951
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1023677069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 FOUNTAINS PKWY STE C",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082165",
            "telephone_number": "618-622-1800",
            "fax_number": "618-622-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 FOUNTAINS PKWY STE C",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082165",
            "telephone_number": "618-622-1800",
            "fax_number": "618-622-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TY PARKER DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-12",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "MCCANN",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-622-1800"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountains Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Becky J Trost, RPH
• Anastasia Tukhtina
• Brittany Renae Turner
• Dawne Akilah Turner
• Melinda Raye Turner, D.C.
• Benedicta Umoru, MD
• Urology of St. Louis, Inc.
• Usv Optical Inc.
• Lynette Vanausdale, PTA
• Lars E Vardaman, PHARM D

• General Practice Dentistry in Fairview Heights, IL
• Providers in Fairview Heights, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.