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General NPI Number Information
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NPI Number | 1265971048
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Entity Type | Individual
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Provider Name | TINA PARK D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 11 LAWRENCE RD
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City | NEWTON
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State | NJ
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Zip | 07860-2794
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Country | US
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Telephone | 973-300-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 29 8TH ST
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2404
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Country | US
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Telephone | 626-244-4294
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Fax | 201-947-2888
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 059942
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22DI02785600
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License Number State | NJ
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