Individual
DR. GRACE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
13869 W BELL RD, SURPRISE, AZ 85374-2468
(623) 584-4015
Mailing address
14245 W BOCA RATON RD, SURPRISE, AZ 85379-8612
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D009068
AZ
Other
Enumeration date
10/27/2014
Last updated
10/27/2014
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