Individual
JOHN JOONTAE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2100 NE BROADWAY ST STE 205, PORTLAND, OR 97232-1500
(503) 284-2893
(503) 287-2016
Mailing address
2100 NE BROADWAY ST STE 205, PORTLAND, OR 97232-1500
(503) 284-2893
(503) 287-2016
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10627
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/19/2016
Last updated
10/21/2024
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