# PUYALLUP PARK DENTAL

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

## Provider details

- **NPI number:** 1164919981
- **Authorized official:** BYUNGJUN PARK DDS (OWNER)
- **Authorized official phone:** (253) 435-0333

## Contact information

- **Practice address:** 13909 MERIDIAN E STE A1, PUYALLUP, WA 98373-9180
- **Practice address phone:** (253) 435-0333
- **Practice address fax:** (253) 435-0362
- **Mailing address:** 13909 MERIDIAN E STE A1, PUYALLUP, WA 98373-9180
- **Mailing address phone:** (253) 435-0333
- **Mailing address fax:** (253) 435-0362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE60048922 | WA | Yes |

## Other

- **Enumeration date:** 04/17/2018
- **Last updated:** 04/17/2018