Individual
DR. DOUGLAS LEE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1201 SE 223RD AVE, SUITE 240, GRESHAM, OR 97030
(503) 666-9800
(503) 666-6787
Mailing address
34116 SE CARPENTER LN, GRESHAM, OR 97080
(503) 663-5162
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D6620
OR
Other
Enumeration date
11/03/2006
Last updated
07/08/2007
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