Zachary Parks, DMD
Individual provider Active NPI Dentist · Kings Bay, GA
NPI 1457087637 · NPPES record last updated May 4, 2023
Key facts
- NPI
- 1457087637
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.033847 (IL)
- Practice address
- 871 Uss James Madison Road
Kings Bay, GA 31547-0000 - Phone
- (217) 722-5127
- NPI assigned
- Jul 28, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033847 | IL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.033847 | IL | Yes |
Addresses
Primary practice location
871 Uss James Madison Road
Kings Bay, GA 31547-0000
Mailing address
871 Uss James Madison Road
Kings Bay, GA 31547
Phone (217) 722-5127
Other providers in Kings Bay, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.