Provider Demographics
NPI:1578851002
Name:YOUNG C. PARK, DDS., PC
Entity Type:Organization
Organization Name:YOUNG C. PARK, DDS., PC
Other - Org Name:PARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:CHUL
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-563-9398
Mailing Address - Street 1:6625 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4631
Mailing Address - Country:US
Mailing Address - Phone:540-563-9398
Mailing Address - Fax:
Practice Address - Street 1:6625 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4631
Practice Address - Country:US
Practice Address - Phone:540-563-9398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412589261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental