# JENNA PARK DMD PLC

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

## Provider details

- **NPI number:** 1174414320
- **Authorized official:** CHRISTINE BARBER (PROVIDER ENROLLMENT MANAGER)
- **Authorized official phone:** (315) 454-6000

## Contact information

- **Practice address:** 6303 E BROADWAY BLVD STE 101, TUCSON, AZ 85710-3547
- **Practice address phone:** (520) 276-1654
- **Mailing address:** PO BOX 70887, CLEVELAND, OH 44190-0887
- **Mailing address phone:** (315) 454-6000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/14/2025
- **Last updated:** 07/14/2025