Provider Demographics
NPI:1952896383
Name:HARK, CHRISTY PARK (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:PARK
Last Name:HARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8580 WYNGATE MANOR CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-8520
Mailing Address - Country:US
Mailing Address - Phone:571-232-4969
Mailing Address - Fax:
Practice Address - Street 1:901 N WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1535
Practice Address - Country:US
Practice Address - Phone:703-706-9564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014161131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice