Provider Demographics
NPI:1083688147
Name:PARK, HENRY INSUK (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:INSUK
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 1:7611 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 106W
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2602
Mailing Address - Country:US
Mailing Address - Phone:703-750-0110
Mailing Address - Fax:703-750-1211
Practice Address - Street 1:7611 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 106W
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2602
Practice Address - Country:US
Practice Address - Phone:703-750-0110
Practice Address - Fax:703-750-1211
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131471223G0001X
NY049343-11223G0001X
VA04014107851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice