Provider Demographics
NPI:1225026651
Name:PARK, INAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:INAH
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24047 W LOCKPORT ST STE 207
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-1683
Mailing Address - Country:US
Mailing Address - Phone:815-267-7878
Mailing Address - Fax:815-267-7979
Practice Address - Street 1:24047 W LOCKPORT ST STE 207
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-1683
Practice Address - Country:US
Practice Address - Phone:815-267-7878
Practice Address - Fax:815-267-7979
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0261401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice