Organization
PARK DENTAL GROUP, LLC
Active
Other names
Palmetto Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAE SUNG PARK (PRESIDENT)
(803) 366-1456
Entity
Organization
Contact information
Practice address
1578 CONSTITUTION BLVD, STE 01, ROCK HILL, SC 29732-3543
(803) 366-1456
(803) 324-0117
Mailing address
1578 CONSTITUTION BLVD, STE 01, ROCK HILL, SC 29732-3543
(803) 366-1456
(803) 324-0117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8288
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8288
—
SC
Enumeration date
12/07/2015
Last updated
12/07/2015
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