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General NPI Number Information
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NPI Number | 1033663596
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Entity Type | Individual
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Provider Name | RYAN PARK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 811 NE ALSBURY BLVD STE 600
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City | BURLESON
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State | TX
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Zip | 76028-2666
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Country | US
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Telephone | 817-529-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 11337 SUMMIT GALE WAY
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City | HASLET
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State | TX
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Zip | 76052-1392
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Country | US
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Telephone | 718-734-8899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 32204
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License Number State | TX
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