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General NPI Number Information
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NPI Number | 1295021533
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Entity Type | Individual
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Provider Name | DAWNELLE PARK DDS
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Gender | Female
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 11/26/2016
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Provider Practice Location Address
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Address Line | 3655 LOMITA BLVD
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City | TORRANCE
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State | CA
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Zip | 90505-3931
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Country | US
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Telephone | 310-303-3860
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Fax |
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Provider Business Mailing Address
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Address Line | 2651 BAYPORT DR
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City | TORRANCE
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State | CA
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Zip | 90503-8923
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Country | US
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Telephone | 310-751-4188
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Fax |
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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 | 61775
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License Number State | CA
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