Christopher Allen Parks, DDS – Periodontics

Key facts

NPI: 1386653095
Entity type: Individual (NPI type 1)
Primary specialty: Periodontics 1223P0300X
License: 20030115559 (MO)
Practice address: 400 Cumberland Way
Suite a
Sullivan, MO 63080-3321
Phone: (573) 468-7556
Fax: (573) 468-7530
NPI assigned: Aug 5, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Christopher a. Parks, DDS, P.C. Dentist · Sullivan, MO · NPI 1407142698

NPD (past) Authorized official

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MO
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20160321000318	MO	Order and Referring Only - Dentist Practitioner - Dentist	1759484579

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
20030115559	MO	MD	Periodontist

Practice roles

Organization	Specialty	Status	New patients
Christopher a. Parks, DDS, P.C.		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Periodontics	1223P0300X	20030115559	MO	Yes

Addresses

Primary practice location

400 Cumberland Way
Suite a
Sullivan, MO 63080-3321

Mailing address

400 Cumberland Way
Suite a
Sullivan, MO 63080-3321
Phone (573) 468-7556

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 3, 2011.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304380800000",
    "number": "1386653095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CUMBERLAND WAY",
            "address_2": "SUITE A",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630803321",
            "telephone_number": "573-468-7556",
            "fax_number": "573-468-7530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CUMBERLAND WAY",
            "address_2": "SUITE A",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630803321",
            "telephone_number": "573-468-7556",
            "fax_number": "573-468-7530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKS",
        "first_name": "CHRISTOPHER",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2011-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MO",
            "license": "20030115559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sullivan, MO

All providers in Sullivan, MO · Periodontics in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.