Healthcare Provider Details

I. General information

NPI: 1942110036
Provider Name (Legal Business Name): HAN NA PARK DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W NAVAJO ST
WEST LAFAYETTE IN
47906-1966
US

IV. Provider business mailing address

720 W NAVAJO ST
WEST LAFAYETTE IN
47906-1966
US

V. Phone/Fax

Practice location:
  • Phone: 765-607-0818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HAN NA PARK
Title or Position: GENERAL DENTIST
Credential:
Phone: 765-607-0818