Provider Demographics
NPI:1699041897
Name:SUN PARK DDS PC
Entity Type:Organization
Organization Name:SUN PARK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-485-9098
Mailing Address - Street 1:102 ELDEN ST STE 17
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4827
Mailing Address - Country:US
Mailing Address - Phone:703-485-9098
Mailing Address - Fax:703-485-8098
Practice Address - Street 1:102 ELDEN ST STE 17
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4827
Practice Address - Country:US
Practice Address - Phone:703-485-9098
Practice Address - Fax:703-485-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412056261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental