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General NPI Number Information
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NPI Number | 1346659562
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Entity Type | Organization
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Legal Business Name | DAVID S PARK DDS INC
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 617 S 8TH ST
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City | EL CENTRO
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State | CA
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Zip | 92243-3218
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Country | US
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Telephone | 760-312-5888
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Fax | 760-312-5918
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Provider Business Mailing Address
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Address Line | 617 S 8TH ST
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City | EL CENTRO
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State | CA
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Zip | 92243-3218
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Country | US
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Telephone | 760-312-5888
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Fax | 760-312-5918
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Authorized Official
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Title or Position | OWNER
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Name | DAVID S PARK
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Credential | DDS
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Telephone | 310-403-1117
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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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