# DR PARK DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** West AV Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790263465
- **Authorized official:** DR. DAVID PARK DDS (CEO)
- **Authorized official phone:** (310) 403-1117

## Contact information

- **Practice address:** 38745 TIERRA SUBIDA AVE STE 150, PALMDALE, CA 93551-4567
- **Practice address phone:** (661) 272-9091
- **Mailing address:** 1669 W AVENUE J STE 305, LANCASTER, CA 93534-2870
- **Mailing address phone:** (661) 802-7544

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 53724 | CA | Yes |

## Other

- **Enumeration date:** 08/03/2018
- **Last updated:** 08/03/2018