Provider Demographics
NPI:1003042649
Name:PARK, LUCY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:H
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 S MASON RD
Mailing Address - Street 2:2524
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7150
Mailing Address - Country:US
Mailing Address - Phone:213-590-8578
Mailing Address - Fax:
Practice Address - Street 1:5303 S MASON RD
Practice Address - Street 2:2524
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7150
Practice Address - Country:US
Practice Address - Phone:213-590-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX285471223D0004X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No1223G0001XDental ProvidersDentistGeneral Practice