MEDICARE: STEPHEN B. PARK, DMD, PLLC.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1568310704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN B. PARK, DMD, PLLC.

Provider Business Mailing Address
First Line	:	4000 E MADISON ST STE 201
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-3160
Country	:	US
Telephone Number	:	206-323-5677
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 E MADISON ST STE 201
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-3160
Country	:	US
Telephone Number	:	206-323-5677
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. STEPHEN B. PARK
Credential	:	DMD
Telephone Number	:	253-561-3731

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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