Provider Demographics
NPI:1336228451
Name:PARK, HAROLD H (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:H
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 1:6651 N CAMPBELL AVE APT 135
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1361
Mailing Address - Country:US
Mailing Address - Phone:520-275-8044
Mailing Address - Fax:
Practice Address - Street 1:5504 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-5540
Practice Address - Country:US
Practice Address - Phone:520-526-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345711223G0001X
AZ71121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice