Provider Demographics
NPI:1326437666
Name:DAVID PARK DENTAL CORP.
Entity Type:Organization
Organization Name:DAVID PARK DENTAL CORP.
Other - Org Name:HIGHLAND DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SANGHO
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-999-0183
Mailing Address - Street 1:3901 MADISON AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5095
Mailing Address - Country:US
Mailing Address - Phone:916-999-0183
Mailing Address - Fax:916-999-0908
Practice Address - Street 1:3901 MADISON AVE STE 5
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5095
Practice Address - Country:US
Practice Address - Phone:916-999-0183
Practice Address - Fax:916-999-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty