Individual
DR. PAUL J PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2601 CLARKE AVE, FORT GREGG-ADAMS, VA 23801
(804) 734-9747
Mailing address
2601 CLARKE AVE, FORT GREGG-ADAMS, VA 23801
(804) 734-9607
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401419061
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0438000506
VA
Other
Enumeration date
08/07/2019
Last updated
01/06/2025
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