Organization
TAE EEN PARK,D.D.S.,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAE EEN PARK DDS (CEO)
(209) 847-2800
Entity
Organization
Contact information
Practice address
190 S OAK AVE STE 6, OAKDALE, CA 95361-3528
(209) 847-2800
(209) 847-2929
Mailing address
190 S. OAK AVE BLDG 3 STE 6, OAKDALE, CA 95361
(209) 847-2800
(209) 847-2929
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
56889
CA
Other
Enumeration date
08/31/2015
Last updated
08/31/2015
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