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General NPI Number Information
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NPI Number | 1164709093
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Entity Type | Organization
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Legal Business Name | PARK DENTAL ASSOCIATES P.C.
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Dates
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Enumeration Date | 11/06/2011
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Last Update Date | 11/06/2011
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Provider Practice Location Address
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Address Line | 1512 SANSOM ST #300
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2809
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Country | US
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Telephone | 215-564-0717
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Fax | 215-564-5450
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Provider Business Mailing Address
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Address Line | 1512 SANSOM ST #300
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2809
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Country | US
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Telephone | 215-564-0717
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Fax | 215-564-5450
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Authorized Official
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Title or Position | PRESIDENT/PROSTHODONTIST
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Name | DR. YEUN-JUNE PARK
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Credential | DMD, MSD
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Telephone | 215-564-0717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DS035815
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License Number State | PA
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