=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144840075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET PARK DDS, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2020
-----------------------------------------------------
Last Update Date | 06/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 HUDSON OAKS DR
-----------------------------------------------------
City | HUDSON OAKS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76087-4712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-717-9653
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3935 CASCADE SKY DR
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76005-1123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-491-1035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 38395
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------