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General NPI Number Information
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NPI Number | 1326437666
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Entity Type | Organization
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Legal Business Name | DAVID PARK DENTAL CORP.
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 3901 MADISON AVE STE 5
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City | NORTH HIGHLANDS
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State | CA
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Zip | 95660-5095
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Country | US
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Telephone | 916-999-0183
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Fax | 916-999-0908
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Provider Business Mailing Address
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Address Line | 3901 MADISON AVE STE 5
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City | NORTH HIGHLANDS
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State | CA
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Zip | 95660-5095
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Country | US
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Telephone | 916-999-0183
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Fax | 916-999-0908
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DAVID SANGHO PARK
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Credential | DDS
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Telephone | 916-999-0183
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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 | 53724
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License Number State | CA
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