Individual
JAE YEON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
400 GALLERIA PKWY SE STE 800, ATLANTA, GA 30339-6413
(800) 920-9947
(678) 904-5666
Mailing address
15 PARKSIDE PL APT 428, REVERE, MA 02151-1154
(339) 223-5869
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22145
MA
Other
Enumeration date
06/12/2008
Last updated
06/12/2008
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