Provider Demographics
NPI:1538323472
Name:PARK, AUDREE DAMYEUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUDREE
Middle Name:DAMYEUN
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAMYEUN
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:67 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1834
Mailing Address - Country:US
Mailing Address - Phone:207-288-4794
Mailing Address - Fax:
Practice Address - Street 1:67 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1834
Practice Address - Country:US
Practice Address - Phone:207-288-4794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist