MEDICARE: MR. STANLEY J PARK D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13144	MD

General Provider Information

NPI Number	:	1285798306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STANLEY J PARK D.D.S

Provider Business Mailing Address
First Line	:	10400 LITTLE PATUXENT PKWY STE 310
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3526
Country	:	US
Telephone Number	:	410-997-8383
Fax Number	:	410-997-8434

Provider Business Practice Location Address
First Line	:	10400 LITTLE PATUXENT PKWY STE 310
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3526
Country	:	US
Telephone Number	:	410-997-8383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	04/16/2026

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