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General NPI Number Information
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NPI Number | 1467886622
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Entity Type | Individual
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Provider Name | HANNA WOO PARK DDS
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Gender | Female
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 1795 MAIN ST SUITE 215
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City | SPRINGFIELD
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State | MA
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Zip | 01103-1077
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Country | US
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Telephone | 413-733-6651
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Fax |
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Provider Business Mailing Address
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Address Line | 1429 PARK ST APT 513
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City | HARTFORD
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State | CT
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Zip | 06106-2236
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Country | US
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Telephone | 917-301-8676
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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 | DN1856385
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License Number State | MA
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