Healthcare Provider Details

I. General information

NPI: 1265001382
Provider Name (Legal Business Name): DAVID PARK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 W WALNUT ST STE A
GARLAND TX
75042-4108
US

IV. Provider business mailing address

225 SHEILA AVE
MURPHY TX
75094-3798
US

V. Phone/Fax

Practice location:
  • Phone: 972-485-1200
  • Fax:
Mailing address:
  • Phone: 214-466-1400
  • Fax: 214-367-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37331
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: