Provider Demographics
NPI:1023653318
Name:PARKER, JALISA RITA (EFDENTAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:JALISA
Middle Name:RITA
Last Name:PARKER
Suffix:
Gender:F
Credentials:EFDENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 GAINESVILLE ST SE APT F
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3277
Mailing Address - Country:US
Mailing Address - Phone:202-352-8266
Mailing Address - Fax:
Practice Address - Street 1:2021 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7007
Practice Address - Country:US
Practice Address - Phone:202-621-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDENA000901126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant