Healthcare Provider Details

I. General information

NPI: 1598455339
Provider Name (Legal Business Name): HA EUN PARK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAEUN PARK

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 N TRUMAN BLVD
FESTUS MO
63028-1176
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2025019296
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: