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General NPI Number Information
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NPI Number | 1043641319
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Entity Type | Organization
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Legal Business Name | D.S PARK DDS, INC
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 25285 MADISON AVE 107
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City | MURRIETA
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State | CA
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Zip | 92562-8981
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Country | US
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Telephone | 951-698-3585
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Fax | 951-698-3581
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Provider Business Mailing Address
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Address Line | 25285 MADISON AVE 107
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City | MURRIETA
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State | CA
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Zip | 92562-8981
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Country | US
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Telephone | 951-698-3585
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Fax | 951-698-3581
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Authorized Official
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Title or Position | OWNER
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Name | DAVID PARK
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Credential | DDS
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Telephone | 951-698-3585
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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 | 53724
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License Number State | CA
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