Individual
JAESEONG PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
800 BOSTON RD, SPRINGFIELD, MA 01119-1352
(413) 796-4700
Mailing address
113 OXBOW RD, FRAMINGHAM, MA 01701-3695
(781) 917-2875
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN1858987
MA
1223G0001X
General Practice Dentistry
Primary
DN1858987
MA
Other
Enumeration date
06/01/2020
Last updated
07/19/2021
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