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General NPI Number Information
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NPI Number | 1316477524
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Entity Type | Individual
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Provider Name | RYAN PARK DMD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 411 HURLEY AVENUE
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City | ROCKVILLE
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State | MD
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Zip | 20850
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Country | US
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Telephone | 224-500-1814
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Fax |
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Provider Business Mailing Address
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Address Line | 13975 CONNECTICUT AVE STE 208
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City | SILVER SPRING
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State | MD
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Zip | 20906-2921
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Country | US
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Telephone |
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 019.031142
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 17982
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.031142
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License Number State | IL
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