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General NPI Number Information
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NPI Number | 1609734086
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Entity Type | Organization
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Legal Business Name | SUSAN PARK DDS, PLLC
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 1370 116TH AVE NE STE 104
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City | BELLEVUE
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State | WA
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Zip | 98004-3825
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Country | US
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Telephone | 425-747-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 1370 116TH AVE NE STE 104
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City | BELLEVUE
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State | WA
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Zip | 98004-3825
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Country | US
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Telephone | 425-747-3080
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SUSAN PARK
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Credential |
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Telephone | 206-883-6720
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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 |
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License Number State |
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