MEDICARE: JOHN 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	D7295	OR

General Provider Information

NPI Number	:	1730181454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J PARK D.D.S

Provider Business Mailing Address
First Line	:	1079 CHAMBERS ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97402-3706
Country	:	US
Telephone Number	:	541-344-7900
Fax Number	:	877-700-4985

Provider Business Practice Location Address
First Line	:	1079 CHAMBERS ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97402-3706
Country	:	US
Telephone Number	:	541-344-7900
Fax Number	:	877-700-4985

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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