MEDICARE: P&J DENTAL CARE 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	122300000X	Dentist	28107	TX
2	122300000X	Dentist	28626	TX

General Provider Information

NPI Number	:	1790178689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P&J DENTAL CARE PLLC

Provider Business Mailing Address
First Line	:	2625 OLD DENTON RD STE 578
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5173
Country	:	US
Telephone Number	:	972-242-7800
Fax Number	:	972-242-7805

Provider Business Practice Location Address
First Line	:	2625 OLD DENTON RD
Second Line	:	SUITE 578
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5125
Country	:	US
Telephone Number	:	347-633-1909
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	HWAN JOO PARK
Credential	:	DDS
Telephone Number	:	972-242-7800

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	03/02/2026

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