Provider Demographics
NPI:1538481569
Name:JASTHI-PARK & ASSOCIATES
Entity Type:Organization
Organization Name:JASTHI-PARK & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-781-7188
Mailing Address - Street 1:2030 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6129
Mailing Address - Country:US
Mailing Address - Phone:410-781-7188
Mailing Address - Fax:410-781-0269
Practice Address - Street 1:2030 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6129
Practice Address - Country:US
Practice Address - Phone:410-781-7188
Practice Address - Fax:410-781-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1407039423OtherINDIVIDUAL NPI
MD1548443831OtherINDIVIDUAL NPI
MD1619952710OtherINDIVIDUAL NPI