MEDICARE: HWAN JOO PARK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	28107	TX

General Provider Information

NPI Number	:	1164778239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HWAN JOO PARK DDS

Provider Business Mailing Address
First Line	:	2625 OLD DENTON RD STE 578
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5173
Country	:	US
Telephone Number	:	972-242-7800
Fax Number	:	972-242-7805

Provider Business Practice Location Address
First Line	:	2625 OLD DENTON RD STE 578
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5173
Country	:	US
Telephone Number	:	972-242-7800
Fax Number	:	972-242-7805

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	02/11/2026

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