Provider Demographics
NPI:1750304192
Name:PHILLIP S.H. PARK DDS.,INC.
Entity Type:Organization
Organization Name:PHILLIP S.H. PARK DDS.,INC.
Other - Org Name:SMART DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:SH
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-405-0707
Mailing Address - Street 1:742 E. COLORADO BLVD.
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2105
Mailing Address - Country:US
Mailing Address - Phone:626-405-0707
Mailing Address - Fax:626-795-2731
Practice Address - Street 1:742 E. COLORADO BLVD.
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2105
Practice Address - Country:US
Practice Address - Phone:626-405-0707
Practice Address - Fax:626-795-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty