Provider Demographics
NPI:1134399389
Name:JIN H PARK DMD AND ASSOCIATES PC
Entity type:Organization
Organization Name:JIN H PARK DMD AND ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-258-1090
Mailing Address - Street 1:920 LAWN AVE
Mailing Address - Street 2:STE A2
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1560
Mailing Address - Country:US
Mailing Address - Phone:215-258-1090
Mailing Address - Fax:
Practice Address - Street 1:920 LAWN AVE
Practice Address - Street 2:STE A2
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1560
Practice Address - Country:US
Practice Address - Phone:215-258-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031108-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty