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General NPI Number Information
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NPI Number | 1780020677
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PLACE SMILES PLLC
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 3670 BRIDGEPORT WAY W UNIT B
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4413
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Country | US
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Telephone | 253-212-3430
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Fax | 253-212-3288
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Provider Business Mailing Address
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Address Line | 3670 BRIDGEPORT WAY W UNIT B
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4413
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Country | US
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Telephone | 253-212-3430
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Fax | 253-212-3288
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MR. YONG K PARK
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Credential | DDS
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Telephone | 253-212-3430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE0009186
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License Number State | WA
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