Individual
SOON SEAN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4366 LOG CABIN DR, MACON, GA 31204-5604
(478) 471-6060
Mailing address
4366 LOG CABIN DR, MACON, GA 31204-5604
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
123888
GA
Other
Enumeration date
05/28/2025
Last updated
10/27/2025
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