Provider Demographics
NPI:1215535182
Name:PARK AND PARK DENTAL GROUP PARTNERSHIP
Entity Type:Organization
Organization Name:PARK AND PARK DENTAL GROUP PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYUNG KEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-524-6119
Mailing Address - Street 1:473 E ALESSANDRO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6021
Mailing Address - Country:US
Mailing Address - Phone:951-789-6886
Mailing Address - Fax:951-780-1998
Practice Address - Street 1:473 E ALESSANDRO BLVD STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-6021
Practice Address - Country:US
Practice Address - Phone:951-789-6886
Practice Address - Fax:951-780-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental