Healthcare Provider Details

I. General information

NPI: 1104408517
Provider Name (Legal Business Name): JULIE PARK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2021
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GALLATIN ST NE
WASHINGTON DC
20011-7533
US

IV. Provider business mailing address

7410 HULL STREET RD STE 101
NORTH CHESTERFIELD VA
23235-5834
US

V. Phone/Fax

Practice location:
  • Phone: 844-796-2797
  • Fax: 202-483-0302
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401418010
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: