MEDICARE: DR. CHRISTINA H PARK DDS, MS

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	122300000X	Dentist	8193	KY
2	1223P0300X	Periodontics	8193	KY

General Provider Information

NPI Number	:	1477888410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA H PARK DDS, MS

Provider Business Mailing Address
First Line	:	3181 BEAUMONT CENTRE CIR
Second Line	:	SUITE 114
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1836
Country	:	US
Telephone Number	:	859-223-0011
Fax Number	:

Provider Business Practice Location Address
First Line	:	3181 BEAUMONT CENTRE CIR
Second Line	:	SUITE 114
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1836
Country	:	US
Telephone Number	:	859-223-0011
Fax Number	:

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

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	11/06/2019

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