# DAWNELLE PARK DDS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093252470
- **Authorized official:** DAWNELLE PARK (OWNER/DENTIST)
- **Authorized official phone:** (310) 303-3860

## Contact information

- **Practice address:** 3655 LOMITA BLVD STE 304, TORRANCE, CA 90505-1925
- **Practice address phone:** (310) 303-3860
- **Practice address fax:** (310) 303-3868
- **Mailing address:** 3655 LOMITA BLVD STE 304, TORRANCE, CA 90505-1925
- **Mailing address phone:** (310) 303-3860
- **Mailing address fax:** (310) 303-3868

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 124Q00000X | Dental Hygienist | — | — | — |
| 126800000X | Dental Assistant | — | — | — |

## Other

- **Enumeration date:** 01/24/2017
- **Last updated:** 01/24/2017