Organization
D PARK MPH DDS DENTAL CORPORATION
Active
Parent organization
D PARK MPH DDS DENTAL CORPORATION
Other names
SMILE DENTAL OF TRACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
D PARK MPH DDS DENTAL CORPORATION
Authorized official
DAVID S PARK (DDS/CEO)
(310) 403-1117
Entity
Organization
Contact information
Practice address
2616 PAVILION PKWY STE 104, TRACY, CA 95304-9408
(209) 839-8333
(209) 839-8338
Mailing address
2616 PAVILION PKWY STE 104, TRACY, CA 95304-9408
(209) 839-8333
(209) 839-8338
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53724
—
CA
Enumeration date
05/11/2021
Last updated
05/12/2021
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