Provider Demographics
NPI:1508462649
Name:D PARK MPH DENTAL, INC.
Entity type:Organization
Organization Name:D PARK MPH DENTAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-403-1117
Mailing Address - Street 1:12021 S. WILMINGTON AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3019
Mailing Address - Country:US
Mailing Address - Phone:888-585-3368
Mailing Address - Fax:661-471-2121
Practice Address - Street 1:12021 S. WILMINGTON AVE STE 1100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3019
Practice Address - Country:US
Practice Address - Phone:888-585-3368
Practice Address - Fax:661-471-2121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:D PARK MPH DENTAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-04
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty