Provider Demographics
NPI:1780020677
Name:UNIVERSITY PLACE SMILES PLLC
Entity Type:Organization
Organization Name:UNIVERSITY PLACE SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-212-3430
Mailing Address - Street 1:3670 BRIDGEPORT WAY W
Mailing Address - Street 2:UNIT B
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4413
Mailing Address - Country:US
Mailing Address - Phone:253-212-3430
Mailing Address - Fax:253-212-3288
Practice Address - Street 1:3670 BRIDGEPORT WAY W
Practice Address - Street 2:UNIT B
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4413
Practice Address - Country:US
Practice Address - Phone:253-212-3430
Practice Address - Fax:253-212-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE0009186261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental