Individual
SAMUEL PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7050 AIR DEPOT BLVD BLDG 1094, TINKER AFB, OK 73145-8716
(954) 290-7165
Mailing address
5306 TRACTOR LN, FAIRFAX, VA 22030-7239
(954) 290-7165
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401417587
VA
Other
Enumeration date
07/10/2021
Last updated
11/24/2024
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