Individual
DR. JONATHAN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7890 E FLORENTINE RD, PRESCOTT VALLEY, AZ 86314-1204
(928) 770-5721
Mailing address
21021 N 56TH ST APT 3086, PHOENIX, AZ 85054-5609
(847) 924-2485
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D010097
AZ
Other
Enumeration date
07/10/2018
Last updated
07/10/2018
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