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General NPI Number Information
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NPI Number | 1710022942
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Entity Type | Individual
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Provider Name | JULIUS PARK D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 1816 EAGLE DR 200-C
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City | WOODSTOCK
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State | GA
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Zip | 30189-8272
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Country | US
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Telephone | 770-926-9260
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Fax | 770-926-9263
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Provider Business Mailing Address
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Address Line | 1816 EAGLE DR 200-C
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City | WOODSTOCK
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State | GA
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Zip | 30189-8272
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Country | US
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Telephone | 770-926-9260
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Fax | 770-926-9263
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22DI02198100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 050223
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN013851
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License Number State | GA
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