Provider Demographics
NPI:1013043777
Name:PARK, DAVID Y (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:Y
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 BRIDGEPORT WAY SW
Mailing Address - Street 2:STE A
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:253-588-1700
Mailing Address - Fax:253-582-2871
Practice Address - Street 1:9101 BRIDGEPORT WAY SW
Practice Address - Street 2:STE A
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-588-1700
Practice Address - Fax:253-582-2871
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE7629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist