Provider Demographics
NPI:1073952321
Name:PARK, AARON (DDS)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
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 1:2384 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3032
Mailing Address - Country:US
Mailing Address - Phone:585-442-5500
Mailing Address - Fax:585-442-5502
Practice Address - Street 1:2384 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3032
Practice Address - Country:US
Practice Address - Phone:585-442-5500
Practice Address - Fax:585-442-5502
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0578471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice