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Organization
SOO T PARK DDS INC
Active
Organization
SOO T PARK DDS INC
Active
Other names
Park Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SOO TAE PARK DDS (OWNER PRESIDENT)
(661) 948-1655
Entity
Organization
Contact information
Practice address
44841 N 10TH ST W, LANCASTER, CA 93534
(661) 948-1655
(661) 940-9636
Mailing address
44841 N 10TH ST W, LANCASTER, CA 93534
(661) 948-1655
(661) 940-9636
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
16496
CA
122300000X
Dentist
22315
CA
122300000X
Dentist
Primary
33967
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G9225701
—
CA
Enumeration date
04/19/2006
Last updated
10/09/2013
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