Provider Demographics
NPI:1790077857
Name:PARK, HUBERT J (DMD, MPH)
Entity Type:Individual
Prefix:
First Name:HUBERT
Middle Name:J
Last Name:PARK
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 FAWCETT ST UNIT 252
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1151
Mailing Address - Country:US
Mailing Address - Phone:617-895-6700
Mailing Address - Fax:
Practice Address - Street 1:80 FAWCETT ST UNIT 252
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1151
Practice Address - Country:US
Practice Address - Phone:617-895-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18560711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry