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General NPI Number Information
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NPI Number | 1548228521
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Entity Type | Organization
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Legal Business Name | KAREN PARK FAMILY DENTISTRY, P.A.
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 125 MEDICAL CIR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3655
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Country | US
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Telephone | 803-796-2637
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Fax | 803-796-5326
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Provider Business Mailing Address
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Address Line | 125 MEDICAL CIR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3655
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Country | US
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Telephone | 803-796-2637
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Fax | 803-796-5326
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Authorized Official
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Title or Position | OFFICE MANAGER/CORPORATE SECRETARY
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Name | JAMES PARK
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Credential |
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Telephone | 803-796-2637
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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 | 3398
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License Number State | SC
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