Provider Demographics
NPI:1043415201
Name:PARK, JOUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SANTA ANITA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4291
Mailing Address - Country:US
Mailing Address - Phone:215-901-4934
Mailing Address - Fax:
Practice Address - Street 1:301 OXFORD VALLEY RD STE 201B
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7708
Practice Address - Country:US
Practice Address - Phone:215-493-5347
Practice Address - Fax:215-493-1176
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist