Individual
JI WON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1605 ROBERTA DR SW, MARIETTA, GA 30008-3855
(770) 419-3120
Mailing address
11 PERIMETER CTR E APT 2304, ATLANTA, GA 30346-1650
(404) 428-4851
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015875
GA
Other
Enumeration date
07/18/2019
Last updated
07/18/2019
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