Provider Demographics
NPI:1760906887
Name:SHERIE PARK DDS, INC.
Entity Type:Organization
Organization Name:SHERIE PARK DDS, INC.
Other - Org Name:SHERIE PARK DENTAL, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-380-1767
Mailing Address - Street 1:3663 W 6TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3047
Mailing Address - Country:US
Mailing Address - Phone:213-380-1767
Mailing Address - Fax:
Practice Address - Street 1:3663 W 6TH ST STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3047
Practice Address - Country:US
Practice Address - Phone:213-380-1767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty