Provider Demographics
NPI:1629546304
Name:DENTAL PRACTICE OF JONAH J PARK DDS INC
Entity Type:Organization
Organization Name:DENTAL PRACTICE OF JONAH J PARK DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-902-8466
Mailing Address - Street 1:7840 FIRESTONE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4257
Mailing Address - Country:US
Mailing Address - Phone:562-923-0997
Mailing Address - Fax:
Practice Address - Street 1:7840 FIRESTONE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4257
Practice Address - Country:US
Practice Address - Phone:562-923-0997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-11
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental