# SJPARK DENTAL, PC

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

## Provider details

- **NPI number:** 1245059492
- **Authorized official:** SUNGBUM PARK DDS (DIRECTOR/ DENTIST)
- **Authorized official phone:** (703) 352-0741

## Contact information

- **Practice address:** 4001 FAIR RIDGE DR STE 105, FAIRFAX, VA 22033-2917
- **Practice address phone:** (703) 352-0741
- **Practice address fax:** (703) 352-0046
- **Mailing address:** 4001 FAIR RIDGE DR STE 105, FAIRFAX, VA 22033-2917
- **Mailing address phone:** (703) 352-0741
- **Mailing address fax:** (703) 352-0046

## Taxonomy

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

## Other

- **Enumeration date:** 10/04/2024
- **Last updated:** 10/04/2024