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Organization
ETHAN PARK DMD INC
Active
Organization
ETHAN PARK DMD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETHAN SB PARK DDS (OWNER DENTIST)
(213) 220-4856
Entity
Organization
Contact information
Practice address
5728 ROSEMEAD BLVD SUITE 220, TEMPLE CITY, CA 91780-1814
(626) 500-4340
(626) 544-5335
Mailing address
5728 ROSEMEAD BLVD UNIT 220, TEMPLE CITY, CA 91780-1814
(626) 544-5335
(626) 544-5335
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100873
DENTIST
CA
Enumeration date
05/12/2021
Last updated
07/13/2023
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