Provider Demographics
NPI:1467412536
Name:PARK, LINDA K (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:K
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 1:35914 HWY 27
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-3737
Mailing Address - Country:US
Mailing Address - Phone:863-422-8338
Mailing Address - Fax:863-422-5268
Practice Address - Street 1:35914 HWY 27
Practice Address - Street 2:SUITE 2B
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3737
Practice Address - Country:US
Practice Address - Phone:863-422-8338
Practice Address - Fax:863-422-5268
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice