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General NPI Number Information
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NPI Number | 1942410501
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Entity Type | Individual
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Provider Name | DAVID S PARK DDS, MPH
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 10390 COLOMA RD STE A
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-2152
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Country | US
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Telephone | 916-368-0440
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Fax | 916-368-0440
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Provider Business Mailing Address
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Address Line | 29 VIA DEL CIELO
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-2511
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Country | US
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Telephone | 310-403-1117
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Fax | 310-403-1117
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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 | 53724
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License Number State | CA
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