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Organization
MM PARK DENTAL INC
Active
Organization
MM PARK DENTAL INC
Active
Other names
Ingleside Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD PARK (OFFICE MANAGER)
(650) 449-8886
Entity
Organization
Contact information
Practice address
1618 SULLIVAN AVE STE 202, DALY CITY, CA 94015-1968
(650) 449-8886
Mailing address
1618 SULLIVAN AVE STE 202, DALY CITY, CA 94015-1968
(650) 449-8886
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
Other
Enumeration date
11/18/2025
Last updated
11/18/2025
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