Provider Demographics
NPI:1891143780
Name:DAVID SANGHO PARK DDS INC
Entity Type:Organization
Organization Name:DAVID SANGHO PARK DDS INC
Other - Org Name:WINNING SMILE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-263-1505
Mailing Address - Street 1:12732 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1303
Mailing Address - Country:US
Mailing Address - Phone:510-233-3100
Mailing Address - Fax:510-233-3434
Practice Address - Street 1:12732 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-1303
Practice Address - Country:US
Practice Address - Phone:510-233-3100
Practice Address - Fax:510-233-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X, 1223E0200X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty