Provider Demographics
NPI:1003434499
Name:PARK, WILLIAM K (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:K
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19969 AUBURN LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7961
Mailing Address - Country:US
Mailing Address - Phone:909-973-4964
Mailing Address - Fax:
Practice Address - Street 1:26741 RANCHO PKWY STE 105-A
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8710
Practice Address - Country:US
Practice Address - Phone:949-716-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-11
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1066611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice