Organization
D S PARK DENTAL CORP
Active
Other names
Antelope Valley Dental Group, AV Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID S PARK DDS, MPH (OWNER)
(310) 403-1117
Entity
Organization
Contact information
Practice address
1037 E PALMDALE BLVD STE 203, PALMDALE, CA 93550-4745
(661) 272-9181
(661) 272-8932
Mailing address
1037 E PALMDALE BLVD STE 203, PALMDALE, CA 93550-4745
(661) 272-9181
(661) 272-8932
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
53724
CA
1223G0001X
General Practice Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53724
—
CA
Enumeration date
03/20/2014
Last updated
07/27/2022
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