Provider Demographics
NPI:1295890374
Name:PARK, DOHEE I (DDS)
Entity type:Individual
Prefix:DR
First Name:DOHEE
Middle Name:
Last Name:PARK
Suffix:I
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 1:47 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2332
Mailing Address - Country:US
Mailing Address - Phone:201-998-1400
Mailing Address - Fax:201-998-1425
Practice Address - Street 1:47 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2332
Practice Address - Country:US
Practice Address - Phone:201-998-1400
Practice Address - Fax:201-998-1425
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021764001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice