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General NPI Number Information
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NPI Number | 1922961325
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Entity Type | Organization
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Legal Business Name | PARK DENTAL STUDIO LLC
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 811 WOODLANE RD
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City | WESTAMPTON
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State | NJ
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Zip | 08060-1049
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Country | US
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Telephone | 609-267-1038
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Fax | 609-267-6563
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Provider Business Mailing Address
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Address Line | 811 WOODLANE RD
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City | WESTAMPTON
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State | NJ
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Zip | 08060-1049
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Country | US
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Telephone | 609-267-1038
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Fax | 609-267-6563
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Authorized Official
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Title or Position | DENTIST
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Name | SOO KYEONG PARK
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Credential | DMD
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Telephone | 347-944-7533
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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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