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General NPI Number Information
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NPI Number | 1457836843
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Entity Type | Individual
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Provider Name | ALBERT CHRISTOPHER PARK DDS
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Gender | Male
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 2902 S 27TH ST
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City | ABILENE
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State | TX
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Zip | 79605-6330
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Country | US
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Telephone | 325-268-0013
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Fax |
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Provider Business Mailing Address
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Address Line | 4333 ANTILLEY RD APT 515
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City | ABILENE
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State | TX
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Zip | 79606-6054
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 34640
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 019030279
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License Number State | IL
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