Healthcare Provider Details

I. General information

NPI: 1568310704
Provider Name (Legal Business Name): STEPHEN B. PARK, DMD, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E MADISON ST STE 201
SEATTLE WA
98112-3160
US

IV. Provider business mailing address

4000 E MADISON ST STE 201
SEATTLE WA
98112-3160
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-5677
  • Fax:
Mailing address:
  • Phone: 206-323-5677
  • 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: DR. STEPHEN B. PARK
Title or Position: OWNER/DOCTOR
Credential: DMD
Phone: 253-561-3731