Organization
DR. PARK DENTAL OFFICE 1, LLC
Active
Other names
Clear Lakes Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J PARK DMD (CEO/PRESIDENT/OWNER)
(651) 444-9644
Entity
Organization
Contact information
Practice address
1550 WHITE BEAR AVE N, SAINT PAUL, MN 55106-1602
(651) 788-7045
Mailing address
1550 WHITE BEAR AVE N, SAINT PAUL, MN 55106-1602
(651) 788-7045
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/08/2022
Last updated
08/08/2022
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