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General NPI Number Information
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NPI Number | 1720271752
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Entity Type | Individual
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Provider Name | TAE-HOON PARK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 1300 N ELLINGTON PKWY
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City | LEWISBURG
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State | TN
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Zip | 37091-2218
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Country | US
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Telephone | 931-359-2825
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 N ELLINGTON PKWY
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City | LEWISBURG
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State | TN
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Zip | 37091-2218
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Country | US
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Telephone | 931-359-2825
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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 | 56079
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 123971
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11619
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License Number State | TN
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