Provider Demographics
NPI:1467188847
Name:D PARK SDS PC
Entity Type:Organization
Organization Name:D PARK SDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SANGHO
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MPH
Authorized Official - Phone:310-403-1117
Mailing Address - Street 1:6375 S PECOS RD STE 119
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3269
Mailing Address - Country:US
Mailing Address - Phone:888-585-3368
Mailing Address - Fax:661-471-2121
Practice Address - Street 1:1811 S RAINBOW BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0855
Practice Address - Country:US
Practice Address - Phone:702-805-4200
Practice Address - Fax:702-805-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty