Provider Demographics
NPI:1437666807
Name:DENTAL PARK OF MCALLEN1, PLLC
Entity Type:Organization
Organization Name:DENTAL PARK OF MCALLEN1, PLLC
Other - Org Name:DENTAL PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHAN MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-309-0944
Mailing Address - Street 1:524 WILDROSE LN APT 1
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7896
Mailing Address - Country:US
Mailing Address - Phone:718-309-0944
Mailing Address - Fax:
Practice Address - Street 1:930 E EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1613
Practice Address - Country:US
Practice Address - Phone:718-309-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-06
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty