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General NPI Number Information
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NPI Number | 1124572284
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Entity Type | Organization
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Legal Business Name | D PARK MPH DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 08/06/2016
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 7743 WEST LN STE C5
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City | STOCKTON
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State | CA
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Zip | 95210-3381
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Country | US
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Telephone | 209-474-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 7743 WEST LN STE C5
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City | STOCKTON
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State | CA
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Zip | 95210-3381
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Country | US
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Telephone | 209-474-1101
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Fax | 209-474-9734
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Authorized Official
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Title or Position | CEO, CFO
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Name | MR. DAVID SANGHO PARK
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Credential | DDS, MPH
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Telephone | 310-403-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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