Provider Demographics
NPI:1467886622
Name:PARK, HANNA WOO (DDS)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:WOO
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 1:1429 PARK ST
Mailing Address - Street 2:APT 513
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2236
Mailing Address - Country:US
Mailing Address - Phone:917-301-8676
Mailing Address - Fax:
Practice Address - Street 1:1795 MAIN ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1077
Practice Address - Country:US
Practice Address - Phone:413-733-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist