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Individual

DR. MARK PARK

Active
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Individual

DR. MARK PARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD, MD

Taxonomy

Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
060757
NY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
22DI02564200
NJ
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
300173
NY

Other

Enumeration date
03/06/2013
Last updated
10/11/2019
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