Provider Demographics
NPI:1386846442
Name:PARK, WON-WOO (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:WON-WOO
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6200 S MCCLINTOCK DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3268
Mailing Address - Country:US
Mailing Address - Phone:480-777-7759
Mailing Address - Fax:480-777-7120
Practice Address - Street 1:6200 S MCCLINTOCK DR
Practice Address - Street 2:SUITE #4
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3268
Practice Address - Country:US
Practice Address - Phone:480-777-7759
Practice Address - Fax:480-777-7120
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65421223X0400X
PADS030803L1223X0400X
NJDI0207341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics