Provider Demographics
NPI:1194216044
Name:PARK, INJEA (DMD)
Entity Type:Individual
Prefix:MR
First Name:INJEA
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 1:160 WASHINGTON ST UNIT 603
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03839-5512
Mailing Address - Country:US
Mailing Address - Phone:603-923-4006
Mailing Address - Fax:
Practice Address - Street 1:234 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-3735
Practice Address - Country:US
Practice Address - Phone:978-819-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-27
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist