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General NPI Number Information
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NPI Number | 1457906257
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Entity Type | Individual
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Provider Name | MICHAEL Y PARK DMD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 1702 TRANSPORTATION BLVD STE F
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City | CROFTON
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State | MD
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Zip | 21114-2151
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Country | US
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Telephone | 410-721-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 TRANSPORTATION BLVD STE F
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City | CROFTON
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State | MD
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Zip | 21114-2151
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Country | US
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Telephone | 267-216-7590
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16989
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License Number State | MD
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