Individual
DONG JIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
490 S BROAD ST, MERIDEN, CT 06450
(203) 237-1000
Mailing address
490 S BROAD ST, MERIDEN, CT 06450
(203) 237-1000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
010794
CT
1223G0001X
General Practice Dentistry
Primary
010794
CT
Other
Enumeration date
07/11/2012
Last updated
09/26/2013
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