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General NPI Number Information
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NPI Number | 1134139397
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Entity Type | Individual
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Provider Name | SUN KUN PARK DMD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 1223 ANNAPOLIS RD STE A
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City | ODENTON
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State | MD
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Zip | 21113-1328
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Country | US
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Telephone | 410-674-7400
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Fax | 410-674-7674
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Provider Business Mailing Address
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Address Line | 1223 ANNAPOLIS RD STE A
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City | ODENTON
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State | MD
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Zip | 21113-1328
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Country | US
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Telephone | 410-674-7400
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Fax | 410-674-7674
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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 | 13052
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License Number State | MD
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