Provider Demographics
NPI:1477888410
Name:PARK, CHRISTINA H (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:H
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 BEAUMONT CENTRE CIR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1836
Mailing Address - Country:US
Mailing Address - Phone:859-223-0011
Mailing Address - Fax:
Practice Address - Street 1:3181 BEAUMONT CENTRE CIR
Practice Address - Street 2:SUITE 114
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1836
Practice Address - Country:US
Practice Address - Phone:859-223-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8193122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist