Healthcare Provider Details

I. General information

NPI: 1760506091
Provider Name (Legal Business Name): MELANIE ARANG KIM-PARK DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 WARD DR SUITE 101
MURFREESBORO TN
37129-0558
US

IV. Provider business mailing address

1833 WARD DR SUITE 101
MURFREESBORO TN
37129-0558
US

V. Phone/Fax

Practice location:
  • Phone: 615-896-3686
  • Fax: 615-896-3645
Mailing address:
  • Phone: 615-896-3686
  • Fax: 615-896-3645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7586
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: