Individual
DR. RYAN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.031142
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
17982
MD
171000000X
Military Health Care Provider
019.031142
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019.031142
DENTAL LICENSE
IL
01
—
17982
DENTAL LICENSE - OFMS
MD
Enumeration date
06/20/2017
Last updated
03/04/2025
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