Provider Demographics
NPI:1376927459
Name:PARK, MIN SUN (DDS)
Entity Type:Individual
Prefix:
First Name:MIN SUN
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:ALL ABOUT SMILES PEDIATRIC DENTISTRY
Mailing Address - Street 2:5036 JERICHO TURNPIKE SUITE #307
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-486-6220
Mailing Address - Fax:
Practice Address - Street 1:ALL ABOUT SMILES PEDIATRIC DENTISTRY
Practice Address - Street 2:5036 JERICHO TURNPIKE SUITE #307
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-486-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0584551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry