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Organization
PARK DENTAL GROUP, LLC
Active
Organization
PARK DENTAL GROUP, LLC
Active
Other names
Palmetto Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAE SUNG PARK (PRESIDENT)
(803) 366-1456
Entity
Organization
Contact information
Practice address
1578 CONSTITUTION BLVD, STE 01, ROCK HILL, SC 29732-3543
(803) 366-1456
(803) 324-0117
Mailing address
1578 CONSTITUTION BLVD, STE 01, ROCK HILL, SC 29732-3543
(803) 366-1456
(803) 324-0117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8288
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8288
—
SC
Enumeration date
12/07/2015
Last updated
12/07/2015
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