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General NPI Number Information
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NPI Number | 1407333990
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Entity Type | Individual
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Provider Name | BRIAN B PARK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL UNIT #15245; BLDG 3031
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City | APO
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State | AP
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Zip | 96271-5245
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Country | US
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Telephone | 315-737-2028
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Fax |
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Provider Business Mailing Address
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Address Line | 3255 LAS PALMAS ST APT 535
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City | HOUSTON
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State | TX
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Zip | 77027-5779
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Country | US
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Telephone | 201-951-9924
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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 | 34445
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License Number State | TX
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