Individual
JAEWOO PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
100 CRAIN HWY S, GLEN BURNIE, MD 21061-3528
(071) 490-0116
Mailing address
810 CONCORDE CIR UNIT 34419, LINTHICUM HEIGHTS, MD 21090-2965
(714) 900-1168
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17153
MD
1223G0001X
General Practice Dentistry
DS041945
PA
Other
Enumeration date
08/26/2018
Last updated
07/28/2021
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