Provider Demographics
NPI:1336710011
Name:DENTAL PARK 4 PLLC
Entity Type:Organization
Organization Name:DENTAL PARK 4 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAN MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-682-1284
Mailing Address - Street 1:1801 S 5TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-2919
Mailing Address - Country:US
Mailing Address - Phone:956-682-1284
Mailing Address - Fax:956-687-8373
Practice Address - Street 1:1801 S 5TH ST STE 112
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2919
Practice Address - Country:US
Practice Address - Phone:956-682-1284
Practice Address - Fax:956-687-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty