Organization
D SANGHO PARK DDS MPH DENTAL CORPORATION
Active
Other names
Smile Dental of San Diego
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID PARK DDS (CEO)
(310) 403-1117
Entity
Organization
Contact information
Practice address
7484 UNIVERSITY AVE STE 150, LA MESA, CA 91942-6084
(619) 462-2272
(619) 462-2290
Mailing address
7484 UNIVERSITY AVE STE 150, LA MESA, CA 91942-6084
(619) 462-2272
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53724
—
CA
Enumeration date
09/12/2018
Last updated
01/06/2020
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