Provider Demographics
NPI:1164709093
Name:PARK DENTAL ASSOCIATES P.C.
Entity Type:Organization
Organization Name:PARK DENTAL ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YEUN-JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:215-564-0717
Mailing Address - Street 1:1512 SANSOM ST
Mailing Address - Street 2:#300
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2809
Mailing Address - Country:US
Mailing Address - Phone:215-564-0717
Mailing Address - Fax:215-564-5450
Practice Address - Street 1:1512 SANSOM ST
Practice Address - Street 2:#300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2809
Practice Address - Country:US
Practice Address - Phone:215-564-0717
Practice Address - Fax:215-564-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0358151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty