Individual
ELLIE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7500 CAMBRIDGE ST STE 5342, HOUSTON, TX 77054-2032
(713) 486-4136
Mailing address
7500 CAMBRIDGE ST STE 5342, HOUSTON, TX 77054-2032
(713) 486-4136
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019033240
IL
Other
Enumeration date
03/02/2023
Last updated
03/02/2023
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