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Organization
PARK FAMILY DENTAL LLC
Active
Organization
PARK FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOON JAE PARK DDS (OWNER)
(262) 720-4669
Entity
Organization
Contact information
Practice address
1001 MADISON AVE, SOUTH MILWAUKEE, WI 53172-2500
(414) 203-9664
Mailing address
W201N5244 SANDPIPER LN, MENOMONEE FALLS, WI 53051-6209
(262) 720-4669
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/04/2023
Last updated
01/04/2023
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