Provider Demographics
NPI:1407085186
Name:PARK, MIHE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIHE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 N SUNRISE AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2841
Mailing Address - Country:US
Mailing Address - Phone:916-786-6431
Mailing Address - Fax:916-252-6767
Practice Address - Street 1:576 N SUNRISE AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2841
Practice Address - Country:US
Practice Address - Phone:916-786-6431
Practice Address - Fax:916-252-6767
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02382800122300000X
CA63112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist