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NPI Code Detail

MEDICARE: ROY H. PARK DDS

MEDICARE: ROY H. 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
11223G0001XGeneral Practice Dentistry051124NY

General Provider Information

NPI Number : 1952403503
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROY H. PARK DDS
Provider Business Mailing Address
First Line : 228 TOWN VIEW DR
Second Line :
City : WAPPINGERS FALLS
State : NY
Zip : 12590-7024
Country : US
Telephone Number : 845-838-0570
Fax Number :
Provider Business Practice Location Address
First Line : 876 DUTCHESS TPKE
Second Line :
City : POUGHKEEPSIE
State : NY
Zip : 12603-1540
Country : US
Telephone Number : 845-454-7023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2006
Last Update Date : 07/08/2007

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