Organization
PARK DENTAL CENTER PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAE EEN PARK D.D.S. (OWNER)
(303) 368-3636
Entity
Organization
Contact information
Practice address
2900 S PEORIA ST STE A, AURORA, CO 80014-3182
(303) 368-3636
Mailing address
2900 S PEORIA ST STE A, AURORA, CO 80014-3182
(303) 368-3636
(303) 368-3631
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8962
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02270781
—
CO
Enumeration date
09/13/2006
Last updated
08/22/2020
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