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Organization
DR. PARK DENTAL OFFICE 1, LLC
Active
Organization
DR. PARK DENTAL OFFICE 1, LLC
Active
Other names
Clear Lakes Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J PARK DMD (CEO/PRESIDENT/OWNER)
(651) 444-9644
Entity
Organization
Contact information
Practice address
1550 WHITE BEAR AVE N, SAINT PAUL, MN 55106-1602
(651) 788-7045
Mailing address
1550 WHITE BEAR AVE N, SAINT PAUL, MN 55106-1602
(651) 788-7045
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/08/2022
Last updated
08/08/2022
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