Provider Demographics
NPI:1144422239
Name:W.W. PARK, D.M.D., P.C.
Entity Type:Organization
Organization Name:W.W. PARK, D.M.D., P.C.
Other - Org Name:OOLI ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WON-WOO
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-782-8330
Mailing Address - Street 1:212 W BROOKHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6339
Mailing Address - Country:US
Mailing Address - Phone:215-782-8330
Mailing Address - Fax:215-782-3266
Practice Address - Street 1:1333 W CHELTENHAM AVE
Practice Address - Street 2:SUITE #202
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3140
Practice Address - Country:US
Practice Address - Phone:215-782-8330
Practice Address - Fax:215-782-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030803L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty